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Background: The effectiveness and increasingly easy access to highly active antiretroviral treatment (ART) have contributed to a considerable drop in HIV-related mortality. However, the mortality of adults in people living with HIV (PLHIV) remains overall higher than in the population in general. The objective of this study was to determine the associated factors with the occurrence of death in (PLHIV) followed in Ziguinchor , in order to improve the care of these patients in our context.Patients and method: This was a cross-sectional, descriptive and analytical study on cohorts of PLHIV followed in the health districts of Ziguinchor during 5 years. All PLHIV, aged 15 and beyond, regularly followed on antiretroviral treatment during the study period in those health districts were included.Results: We included 804 patients, women represented 597 (74.25%), i.e. a sex ratio (F/M) of 2.88. The average age was 45.61 ± 13.01 years with extremes from 15 to 96 years. The 46-60 age group was the most represented, 297 (36.94%). 286 patients (35.58%) were diagnosed at stages 3 and 4 of WHO. 82.34% were infected with HIV1. HIV2 was found in 122 (15.17%) patients and the dual profile in 20 cases (2.49%). The average CD4 count was 327±295/mm3 with extremes from 1 to 2156/mm3. Two hundred and thirteen patients (40.73%) had a CD4 count below 200/mm3 and 117 patients (22.37%) had a CD4 count above 500/mm3. Antiretroviral treatment was initiated in 791 patients (98.38%). The antiretroviral regimen combined 2 NRTIs (nucleoside reverse transcriptase inhibitor) with 1 NNTI (non-nucleoside reverse transcriptase inhibitor) in 82.71% of cases. The average length of follow-up was 3.22±1.33 years (range 1 to 6 years). In multivariate analysis, the occurrence of death was associated with age greater than 65 years (p = 0.027), treatment duration < 12 months (p 0.005), delay in ARV treatment (CD4 at baseline less than 500 cells/mm3 (p=0.001) and high viral load greater than 1000 copies/mL (p=0.000) at baseline).Conclusion: Strengthening screening, early initiation of ART, strengthening the therapeutic arsenal of antiretrovirals, are the main factors to be taken into consideration in order to reduce mortality in HIV-infected patients.

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.

Background Hemodialysis patients are among high-risk groups for COVID-19. Africa is the continent with the lowest number of cases in the general population but we have little information about the disease burden in dialysis patients. Objectives This study aimed to describe the seroprevalence of SARS-CoV-2 antibodies in the hemodialysis population of Senegal. Patients and methods We conducted a multicenter cross-sectional survey, between June and September 2020 involving 10 public dialysis units randomly selected in eight regions of Senegal. After seeking their consent, we included 303 patients aged ≥ 18 years and hemodialysis for ≥ 3 months. Clinical symptoms and biological parameters were collected from medical records. Patients’ blood samples were tested with Abbott SARS-CoV-2 Ig G assay using an Architect system. Statistical tests were performed with STATA 12.0. Results Seroprevalence of SARS-CoV-2 antibodies was 21.1% (95% CI = 16.7–26.1%). We noticed a wide variability in SARS-CoV-2 seroprevalence between regions ranging from 5.6 to 51.7%. Among the 38 patients who underwent nasal swab testing, only six had a PCR-confirmed infection and all of them did seroconvert. Suggestive clinical symptoms were reported by 28.1% of seropositive patients and the majority of them presented asymptomatic disease. After multivariate analysis, a previous contact with a confirmed case and living in a high population density region were associated with the presence of SARS-CoV-2 antibodies. Conclusion This study presents to our knowledge the first seroprevalence data in African hemodialysis patients. Compared to data from other continents, we found a higher proportion of patients with SARS-CoV-2 antibodies but a lower lethality rate.

Resume Connue depuis un peu moins d’un demi-siecle, la borreliose, ou maladie de Lyme, est une zoonose transmise par la tique. Elle est la maladie vectorielle la plus rependue en Europe et aux Etats-Unis. Le Borrelia burgdorferi sensu lato, la bacterie en cause, est dote d’un « systeme de ruse » qui lui permet de dejouer la defense immunitaire et d’implanter l’infection sur le mode chronique. Il engendre des lesions tissulaires multisystemiques mediees par la reponse inflammatoire de l’hote. L’atteinte renale est rarement rapportee et elle est mieux connue chez le chien sous l’appellation de nephrite de Lyme. Le premier cas d’atteinte renale chez l’homme est decrit en 1999 et, depuis, huit autres cas ont ete rapportes. L’atteinte est preferentiellement glomerulaire et les formes histologiques varient entre les nephropathies a depots de complexes immuns et la podocytopathie. Les mecanismes physiopathologiques semblent etre triples : depots de complexes immuns, hyperexpression podocytaire de la proteine membranaire B7-1, et infiltration renale de cellules inflammatoires. En se basant sur les connaissances accumulees sur la maladie en un peu plus de 40 ans, l’objectif de cette revue est d’etablir les hypotheses physiopathologiques de l’atteinte renale afin de mieux definir les lesions histologiques.

Introduction: Diabetic nephropathy is the most common cause of kidney disease in diabetics. However, in some cases the clinical symptoms is not typical and nephropathy may be different from diabetic and require the use of renal biopsy (RB) which is not usually indicated unless non-diabetic nephropathy (NND) is suspected. The objective of this study was to evaluate the prevalence of non-diabetic nephropathy (NDN) among the diabetic patients and to analyse the different predictive factors of its occurrence. Patients and methods: It was a retrospective, descriptive and analytical study which is carried out at the nephrology department of Aristide Le DANTEC hospital of Dakar over a period of 60 months. Diabetics with suspected NDN diagnosis based on renal anomalie that is associated with a recent diabetes, Acute renal failure with rapid progress, Diabetic retinopathy’s absence, and Extrarenal signs (cutaneous, digestive and articular) associated with an acute renal failure. Microscopic haematuria was included. The epidemiological, clinical, biological and histological parameters were collected and analysed using the SPSS, 3.5 version software. Results: Out of 34 biopsied diabetic patients, 12 had NDN that is a prevalence of 35, 3%. The average age was 49.88 ± 4.15 years, 0.78 for the sex-ratio and the mean duration of diabetes is 12.53 ± 4.7 years. Glomerular syndrome was found in 30 patients (88.23%), vascular nephropathy syndrome in 3 patients (8.82%) and tubule-interstitial nephropathy syndrome in only one patient (2.94%). Diabetic retinopathy (DR) and microscopic haematuria (HU) respectively existed in 10 patients (34%) and 15 patients (44. 12%). The Kidney biopsy (KB) indications were renal abnormalities associated with recent diabetes, acute renal failure with rapid progress, absence of DR, extrarenal signs associated with acute renal failure and microscopic haematuria. Twenty-two patients (64.7%) had diabetic nephropathy (DN) and 12 patients (38.2%) presented a NDN. Predictive factors of NDN diagnosis were a shorter diabetes duration (P = 0.0008), high blood pressure (P = 0.0015) and absence of DR (P = 0.005). Conclusion: Our data show that kidney injury in a diabetic is not always diabetic nephropathy. The Kidney biopsy (KB) is often needed in order to adopt an effective management.

L´objectif de ce travail était de faire un état des lieux de l´hémodialyse chronique pédiatrique au Sénégal. Il s´agissait d´une enquête transversale descriptive et analytique concernant tous les centres publics ayant admis des enfants en hémodialyse chronique du 1er janvier 2016 au 31 décembre 2017; sur les 08 centres fonctionnels à cette période, 06 ont été retenus. Au total, nous avions recensés 311 patients hémodialysés dont 08% (n=25) étaient des enfants. L´âge moyen des enfants dialysés était de 13,92 ans ± 3,67 ans. Le sex-ratio était de 0,66. Les glomérulonéphrites chroniques identifiées représentaient 24% (n=6) dont 50% (n=3) de HSF primitive. La fistule artério-veineuse (FAV) était utilisée dans 36% (n=9) des cas. Le consommable de dialyse utilisé était gratuit pour tous les enfants et leur famille (100%). La presque totalité des enfants dialysés 96% (n=24) étaient régulièrement hémodialysés à raison de trois séances par semaine. Le décès était observé chez 44% (n=11) au cours des 16 premiers mois après l´initiation à la dialyse. Parmi les patients vivants, 86% (n=12) étaient toujours en hémodialyse. Un patient avait été transféré en dialyse péritonéale continue ambulatoire (DPCA) et un autre transplanté en France grâce à un don intrafamilial; les débuts de l´hémodialyse pédiatrique au Sénégal étaient confrontés à de nombreuses difficultés liées au faible accès des enfants malgré la gratuité de la dialyse et le vote de la loi autorisant la transplantation rénale depuis décembre 2015. Nous recommandons l´élaboration d´un projet thérapeutique pour la prévention et la prise en charge des enfants atteints de maladie rénale chronique.

Resume Introduction Le delai diagnostique long a comme corollaire, une extension des lesions radiologiques et une dissemination de la tuberculose dans la communaute. Ces lesions extensives peuvent guerir au prix de sequelles importantes souvent source de handicap respiratoire. Objectif Decrire le parcours des soins aboutissant au retard diagnostique de la tuberculose et caracteriser les lesions radiologiques. Methodologie Etude transversale prospective, a visee descriptive et analytique portant sur 66 dossiers de patients tuberculeux bacilliferes. Resultats Le delai diagnostique moyen etait de 16 (± 15) semaines ; soit 22 (± 14,1) semaines dans le genre feminin versus 14,6 (± 14,3) semaines dans le genre masculin (p = 0,10). Les premiers recours de soins etaient respectivement les centres de sante (62,1 %), les pharmacies (51,9 %) et la medecine traditionnelle (28,7 %). Seuls 27,2 % des patients ont eu recours aux marabouts. Les anomalies radiologiques bilaterales, en analyse bivariee etaient associees a la consultation au centre de sante (66,7 % versus 33,3 % ; p Conclusion Ces resultats doivent inciter a envisager dans l’urgence des interventions appropriees de sensibilisation, d’information des patients et du personnel medical sur la realite de la tuberculose afin de prevenir sa dissemination souvent source d’incapacite respiratoire et de sequelles radiologiques.

Introduction: Patients with end-stage chronic renal failure (ESKD) have a significant impairment in their nutritional status. Our study is aiming at evaluating the nutritional status based on clinical and biological parameters. Patient and method: This is a prospective, cross-sectional, descriptive and analytical study carried out in two departments of nephrology/dialysis in Niger from 1 December 2014 to 31 March 2015. The assessment of nutritional status relied on the Body Mass Index (BMI), albuminemia, serum phosphate, hemoglobin, CRP, urea, creatinine levels. Results: Sixty-five patients were involved in the study. The mean age was 44.35 ± 13 years with a sex ratio of 2.09 in favor of men and an average dialysis duration of 43.47 ± 36.55 months. The mean BMI was 21.60 ± 4.47 kg/m2. Undernutrition was noted in 19 patients (29.23%), hypoalbuminemia was found in 13 patients, C-reactive protein (CRP) level was high in 11 patients. In comparative analysis according to the BMI, several parameters were significantly related to undernutrition: hypo-albuminemia, hyperphosphatemia, high CRP, hyperazotemia, anorexia, MUAC, comorbidities, central venous catheter. Conclusion: The prognostic value of undernutrition in chronic hemodialysis patients fosters early recognition and management of all nutritional disturbances in these patients. Assessment and monitoring of nutritional status in chronic hemodialysis require the simultaneous determination of several markers in order to weight the limits of each of the criteria taken in isolation.

Introduction: High blood pressure (HBP) is a worldwide health issue responsible of high cardiovascular morbidity and mortality. Even though essential HBP is far the most frequently reported in patients, secondary causes must be known because of their severity and the possibility of aetiological treatment. No recent epidemiological data are available about secondary causes of HBP in black African populations. The aim of this study was to describe aetiological patterns of secondary HBP in patients followed at Saint-Louis Hospital. Patients and Method: We conducted a retrospective and descriptive study in regional hospital of Saint-Louis. All patients aged ≥15 years old admitted from January 1st 2011 to January 31st 2015 in internal medicine, nephrology, emergency and cardiology departments were included. Clinical, paraclinical data and patients outcomes were collected from medical records. Hypertension was defined according to JNC8 criteria. Secondary HBP was considered if explorations identified a clear aetiology to hypertension. Statistical analysis was done with Excel 2010 and STATA 12.0. Results: We included 9253 patients with mean age of 35 ± 12 years (15 - 83 years) and sex-ratio of 1.6. Overall 67.5% of patients had hypertension and secondary causes were found in 10.5% of them. The majority of patients presented clinical symptoms suggesting a secondary cause of HBP and first-line laboratory explorations were normal in half of cases. Renal diseases were responsible for 79.1% of secondary HBP cases mainly dominated by glomerulonephritis (22.6%), vascular nephropathies (18.7%) and autosomal dominant polycystic kidney disease (5.8%). They were followed by preeclampsia (13.6%) and endocrinal aetiologies such as hyperthyroidism (5.8%), hypercorticism (0.5%), pheochromcytoma (0.5%), primary hyperparathyroidism (0.4%) and Conn’s adenoma (0.1%). Combination of ≥3 antihypertensive drugs was necessary in 71.5% of cases and surgical treatment was performed in three patients. Blood pressure was normalized in only 27.7% of patients. Conclusion: Secondary causes are frequent in our young patients with HBP. In the majority of patients complete clinical examination and minimal laboratory investigations recommended by World Health Organisation can give an aetiological orientation that needs further radiological and hormonal explorations.

Known in less than half a century, borreliosis, or Lyme disease, is a zoonosis caused by the tick bite. It is the most common vector disease in Europe and the United States. Borrelia burgdorferi sensu lato, the bacterium in question, is fitted with a "cunning device" that allows it to trick the immune system and implant the infection chronically. It causes multi-system tissue damage mediated by the inflammatory response of the host. Renal involvement is rarely reported and is better known in dogs as Lyme nephritis. The first case of kidney impairment in the human being was described in 1999, and since then eight other cases have been reported. The involvement is preferentially glomerular; the histological forms vary between immune complex nephropathy and podocytopathy. The pathophysiological mechanisms appear to be triple: immune complex deposits, podocytic hyper-expression of the B7-1 membrane protein, and renal infiltration of inflammatory cells. On the basis of the accumulated knowledge of the disease in just over 40 years, this review aims at establishing the physio-pathological hypotheses of renal involvement in order to better define the histological lesions.

Elderly hemodialysis patients particularly suffer from protein-energy wasting syndrome due to age-related physiological changes. We carried out an observational study from 1 to 30 April 2016 involving 31 elderly hemodialysis patients in the center of Cahors University Hospital. We intended to check how close the 3 methods of nutritional evaluation were, namely ingesta, albumin/prealbumin association and Subjective Global Assessment. We trialed the nutritional status of each patient using the above methods. The mean age was 77.7 ± 7.07 years with M/F ratio of 0.63. Exposure to dialysis was 40.61 ± 67.88 months on average. The mean BMI was 26.67 ± 9.17 kg/m2. The average daily calorie and protein intake was 1297.61 ± 321.73 Kcal and 52.87 ± 9.89 g, respectively. The average branchial perimeter was 27.53 ± 2.47 cm with a mean triceps skinfold of 9 ± 0.7. The daily protein intake assessed by the nPCR was 0.95 ± 0.21 g/kg/day. The mean albumin and pre-albumin levels were 37.32 ± 1.41 g/l and 283.22 ± 35.35 mg/l. The average Kt/V was 1.98 ± 0.35. According to the SGA, 26 (83.87%) were in good nutritional status (subgroup 1), 3 (9.67%) were suffering from mild undernutrition (subgroup 2) and 2 (6.46%) had acute undernutrition (subgroup 3). Relying on albumin and prealbumin levels, 18 (58.06%) were in good nutritional status, 6 (19.36%) had mild undernutrition and 7 (22.58%) acute undernutrition. According to the ingesta, 2 (6.46%) patients were in subgroup 1, 8 (25.81%) patients in subgroup 2 and 21 (67.74%) in subgroup 3. No agreement was found between the 3 evaluators of nutritional status (kappa to assess SGA and albumin-pre-albumin association at -0.075 [95% confidence interval: -0.175 to 0.024]; kappa as a measurement for SGA and ingesta at 0.073 [95% range: -0.007 to 0.153], kappa for albumin-prealbumin combination and ingesta at 0.034 [95% confidence interval: -0.058 to 0.126)]. Disjunction between the three nutritional evaluators used in our study, in addition to inherent bias in the low number of staff, provides information on the nutritional problems of elderly hemodialysis patients, especially underestimation of nutritional surveys in relation to actual energy intake, nutritional impact of the physiological and socio-economic changes that accompany aging and the lack of nutritional methods and standards specific to this category of population.

Summary: Tuberculosis is a common infectious disease in chronic hemodialysis due to alteration of the immune system associated with chronic kidney disease. The objectives of this study are to determine the prevalence of tuberculosis in chronic hemodialysis patients and to identify its diagnostic and therapeutic difficulties. Methods and patients: This was a descriptive retrospective study over a period of 20 years (1994-2014). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Aristide Le Dantec University Teaching Hospital in Dakar which clinical symptoms and laboratory favor tuberculosis. Results: Of 258 chronic hemodialysis patients treated in Hospital Aristide Le Dantec hemodialysis center, 29 cases (11.4%) of tuberculosis disease are diagnosed. The mean age is 43.21 ± 12.48 years, and the sex-ratio is 0.8. The median time to onset of tuberculosis after initiation of hemodialysis is 22.86 ± 28.86 months. The diagnosis of tuberculosis is sure only in 17% of cases. Extra-pulmonary sites are found in 79% of cases. The average duration of treatment is 9.39 ± 1.64 months (6 - 13 months). Various treatment protocols are adopted. Mortality is 21%, 50% due to disseminated tuberculosis. Conclusion: The diagnosis of tuberculosis in the chronic hemodialysis patients is often difficult due to the atypical symptoms, the frequency of extra-pulmonary location and the lack of evidence of sure diagnosis.

Introduction: Acute renal failure (ARF) is one of the most daunting complications in severe malaria. The features of ARF in malaria are not well-known in Senegal. Our purpose when carrying out this study was to describe the epidemiological, clinical, Para clinical, treatment and outcome of those manifestations. Patients and Methods: This was a descriptive retrospective study over a 3 year period, from 1 January 2011 to 31 December 2014. The people involved were patients with acute kidney failure during malaria. ARF in malaria was defined as urine output of less than 400 ml/24 hour or creatinine level greater than 13 mg/l (adults), diuresis of less than 12 mL/kg/24 hour or higher creatinine level with respect to the age (children). The data collected were analyzed using SPSS software. Results: During the study period, we selected records of 11 patients, including 5 children and 6 adults. The average age of children was 12 ± 2.34 years; it was 30.83 ± 15.34 years for adults. The sex ratio was 1.75. Eight patients had vomiting. Fever was observed in 10 patients. Impaired consciousness was present in 5 patients. Anuria was noted in 3 patients; 6 patients had edema syndrome. Urea average rate was 3.72 ± 1.43 g/L, and the mean value of creatinine level was 149.96 ± 39 mg/L. There was positive thick blood in 6 out of 7 patients, and the mean parasite density was 18,106.5 ± 14,228.5 parasites per μl. The mean hemoglobin level was 6.09 ± 1.71 g/dl. Thrombocytopenia was present in 6 patients (54.5%). The kidneys were well-differentiated in 4 patients. Acute tubular necrosis was diagnosed in 7 patients (63.6%). Quinine was administered in 9 patients. Hemodialysis was performed in nine patients. The outcome was favorable in 5 patients (2 adults and 3 children), 2 children died. Conclusion: This study has allowed us to notice serious cases of ARF in severe malaria, especially in children. This was diagnosed too late most of the time. Senegal must implement all human and technical resources to detect ARF in malaria as early as possible. Access to renal replacement therapy should also be facilitated.

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.

Aim: Vascular access is important for a good survive in hemodialysis. It can be temporary or permanent, and needs particular attention because of possible complications, especially infectious. We conducted a study to determine the type and the outcome of vascular access in two hemodialysis units in Dakar. Materials and Methods: A multicenter retrospective study was conducted from the 1st January 2005 to 10 September 2010 in two hemodialysis centers: Hospital Aristide Le Dantec and the MDTC (Multifunctional Diagnosis and Treatment Center) of Dakar. All the patients- regularly dialyzed since at least three months in these centers were included. Results: Sixty five patients were included. The mean age was 50.2 years with a sex ratio of 1.7. The mean duration in hemodialysis was 23.2 month. Only five patients (7.80%) had an AVF before starting in hemodialysis. Sixty patients (92.2%) started dialysis with a central venous catheter. Among them, 49 (81.6%) had a double lumen femoral catheter and 11 had a jugular one with 4 tunneled. Complications of vascular access were noted for 23 patients (39.7%) with 12 infections. Blood culture was positive for Staphylococcus Aureus in seven cases. Seven patients presented lower limb thrombophlebitis. Thrombosis of the catheter was noted in four patients. Radial arterio-venous fistula (AVF) was the first intention permanent access in 41 cases (64.1%) followed by cephalic AVF in 14 cases (21.9%) and basilic AVF in 9 (14%). AVF complications were presented in 56.9% of case (40 patients). Most of them was early defect in 18 cases (27.7%), thrombosis in 9 (13.8%) and stenosis in 5 (7.7%). Radial AVF infection to Staphylococcus Aureus was noted in 3 cases, and one pseudo aneurysm was noted. Conclusion: Vascular access for hemodialysis is a great problem in Senegal. More than two third of our patients start dialysis on venous catheters, this is far from the clinical practice guidelines.

Introduction Un abord vasculaire de qualite est indispensable pour tout patient en hemodialyse chronique. Le but de cette etude est de faire un etat des lieux des abords vasculaires chez tous les hemodialyses du Senegal. Patients et methodes Etude prospective, multicentrique, transversale allant du 1er juin au 30 juin 2016 realise dans tous les centres d’hemodialyse publiques et prives du Senegal. Tous les patient atteints d’une maladie renale chronique de stade V, traitee par hemodialyse depuis au moins 3 mois ont ete inclus. Resultats Quatre cent douze patients (412) ont ete colliges. L’âge moyen etait de 47,76 ans (11–85 ans). Il y avait 207 femmes (50,2 %) et 205 hommes (49,8 %). Le sex-ratio etait de 0,99. La duree moyenne en hemodialyse etait de 36,95 mois. Les premieres seances d’hemodialyse ont ete effectuee sur un catheter veineux central chez 378 patients (91,75 %). Deux cent quatre-vingt-six patients (69,40 %) avaient comme abord vasculaire actuel une fistule arterio-veineuse (FAV) et 126 patients (30,60 %) dialysaient sur un catheter veineux central. Soixante-dix-neuf patients (62,7 %) avaient un catheter tunnelise, 26 patients (20,6 %) avaient un catheter jugulaire simple et 21 patients (16,7 %) avaient un catheter femoral double lumiere. La duree moyenne d’utilisation des catheters veineux centraux (CVC) etait de 7,66 mois (1–72 mois). Discussion Le guide de bonne pratique en hemodialyse (K DOQI) recommande l’utilisation de moins de 20 % de catheters centraux temporaires dans une unite d’hemodialyse [1] . Une premiere etude menee a Dakar, au Senegal avait retrouve chez 89,20 % des patients, un catheter veineux central comme premier abord d’hemodialyse [2] . Dans notre etude 91,7 % avaient un catheter veineux central comme premier abord vasculaire. Conclusion L’utilisation de catheter veineux central pour hemodialyse en premiere intention reste frequente au Senegal d’ou l’interet de former les chirurgiens des hopitaux regionaux a la confection de fistules arterio-veineuses.

Introduction La tuberculeuses est tres frequente chez l’hemodialyse chronique, du fait de l’alteration du systeme immunitaire liee a l’insuffisance renale chronique, et aggravee par la dialyse. Les signes revelateurs sont peu specifiques d’ou un retard diagnostique et therapeutique. Les objectifs de ce travail etaient de preciser la prevalence de la tuberculose chez l’hemodialyses chronique a Ziguinchor et de montrer l’apport du GENEXPERT dans le diagnostique de cette derniere. Patients et methodes Il s’agit d’une etude prospective longitudinale sur quatorze (14) mois, incluant les patients en hemodialyse periodique au centre d’hemodialyse de Ziguinchor presentant des symptomes cliniques et/ou paracliniques en faveur d’une tuberculose. Resultats Sur 30 patients hemodialyses chroniques durant la periode d’etude, 7 cas de tuberculose maladie etaient colliges, soit une prevalence de 23,33 %. Il y avait 5 hommes et 2 femmes (5 H/2 F). L’âge moyen etait de 37 ans [18–67 ans]. La duree moyenne en hemodialyse etait de 16 mois [8–60 mois]. L’intervalle entre le debut de l’hemodialyse et la decouverte de la tuberculose etait en moyenne de 8 mois. Le premier signe revelateur etait une fievre inexpliquee et des sueurs profuses dans 6 cas (85,8 %). Le GENEXPERT a confirme l’atteinte tuberculeuse dans 6 cas (85,8 %) (1 cas dans le liquide de ponction pleurale, 2 cas dans le liquide de ponction d’ascite et 3 cas dans le liquide de ponction pleurale et peritoneale). Les localisations extra-pulmonaires etaient trouvees dans 6 cas (85,8 %). L’evolution chez nos patients etait favorable dans 5 cas (71,4 %) et defavorable dans 2 cas (deces). Discussion Les signes cliniques revelateurs sont souvent peu specifiques, ce qui rend le diagnostic difficile. Les tests cutanes chez l’hemodialyses sont presque toujours negatifs suite au deficit immunitaire. Toutes les etudes sont unanimes sur la grande frequence des localisations extra-pulmonaires de la tuberculose chez l’hemodialyse. Dans notre serie, 85,8 % (6 cas) ont une localisation extra-pulmonaire. Conclusion Les manifestations cliniques de la tuberculose chez les hemodialyses chroniques sont peu specifiques. La localisation est surtout extra-pulmonaire. Le GENEXPERT est un outil de diagnostic de certitude et permet de diminuer la mortalite.

Introduction Acute renal failure (ARF) is a serious obstetric complication of pregnancy, a real health problem in developing countries. It is more related to the pathologies of pregnancy affecting the mother rather than the fetus. The purpose of our study was to assess sociodemographic, clinical, therapeutic and evolutionary features in obstetric acute renal failure. Materials and Methods: A cross sectional study of 6 months (August 2015- January 2016) was conducted. The study involved pregnant women over 20- week amenorrhea including the immediate postpartum admitted for acute renal failure. Results: Thirty-two patients were involved. The mean age was 25.21 ± 5.14 years. Most of them were first-time mothers (53.1%). Surrounding hospital exits account for 71.9% of the admissions. 31.25% (N = 10) of the patients did not receive any antenatal care. The main clinical signs at admission were hypertension (86.6%), oliguria (40.5%) and edema syndrome (37.5%). Eclampsia and severe pre-eclampsia represented the causes of the ARF in 68.75% cases. Considering 8 patients (25%) who were supposed to undergo dialysis therapy, only one took the treatment. The average hospital stay was 15.20 ± 7.45 days. Renal function resolved in 68.75% of patients and 15.62% developed chronic renal sequelae. At the end of the study, we recorded 5 cases of maternal deaths and 10 cases of fetal death in utero. Conclusion: Obstetric ARF remains a serious complication of pregnancy for mother and child. It should be noted that hemodialysis was not accessible to all patients who were entitled to it due to lack of financial means. Therefore, regular monitoring of pregnancies should be prioritized, and, if possible, ensure that hemodialysis sessions are funded.

Introduction La peritonite infectieuse en dialyse peritoneale (DP) est une complication frequente et potentiellement grave. En Afrique subsaharienne, ou la DP est peu developpee, le traitement empirique est base sur des ecologies bacteriennes non locales. Apres 10 ans d’experience, nous avons realise cette etude qui avait pour objectifs de determiner la prevalence de la peritonite, son ecologie bacterienne et d’evaluer l’efficacite des protocoles therapeutiques entrepris pour son traitement. Patients et methodes Il s’agit d’une etude retrospective realisee sur une periode de 2 ans, du 1er janvier 2011 au 31 decembre 2013 dans une unite de DP d’Afrique subsaharienne. Les patients traites par dialyse peritoneale ayant presente une peritonite ont ete inclus. Les parametres bacteriologiques, therapeutique et evolutif ont ete etudies. Pour toute bacterie isolee, nous avons etudie sa sensibilite aux differents antibiotiques disponibles. Resultats Le taux de peritonites etait de 21,03 peritonites/mois-patients. Il y avait 32 hommes et 19 femmes soit un sex-ratio de 0,6. L’infection du site d’emergence du catheter etait retrouvee chez 43 patients (59,72 %). Cinquante patients etaient sous dialyse peritoneale continue ambulatoire (DPCA) et un seul etait sous dialyse peritoneale automatisee (DPA). Les bacteries Gram positif etaient isolees dans 60,78 %, les bacteries Gram negatif dans 39,22 %. Staphylococcus aureus etait identifie chez 45,12 % des patients, Pseudomonas aeruginosa chez 17,64 % des patients. Parmi les S. aureus une seule souche etait resistance a la cefoxitine, deux souches etait meti-R et aucune resistance a la vancomycine n’a ete retrouvee. Discussion Notre unite de DP a ete inauguree en mars 2004. C’est le premier centre de DP chronique en Afrique de l’Ouest. Il prend en charge environ 20 nouveaux cas par an. Dans notre serie, on note une faible resistance aux antibiotiques testes ce qui laisse supposer qu’il s’agit dans la plupart du temps d’infections a germes communautaires. Conclusion L’infection peritoneale reste relativement frequente chez nos patients. Les bacteries Gram positif etaient les germes les plus isoles. Cependant la prevalence des peritonites dans notre unite reste en adequation avec les normes des societes savantes.

Introduction Peu de pays d’Afrique subsaharienne disposent de registre de biopsie renale. L’objectif de ce travail etait de determiner les indications de la PBR, et de decrire les aspects histopathologiques et etiologiques des nephropathies biopsiees dans un pays d’Afrique subsaharienne. Patients et methodes Il s’agit d’une etude retrospective descriptive realisee dans un service de nephrologie d’Afrique Subsaharienne, sur une periode de 4 ans (1er janvier 2009 au 31 decembre 2012). Etaient inclus les patients 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 Quatre cent quatre-vingt-douze (492) PBR ont ete realisees durant la periode d’etude. L’âge moyen des patients etait de 28 ± 14,8 ans. Il y avait 294 hommes pour 198 femmes, soit un sex-ratio de 1,48. Le syndrome nephrotique etait la principale indication dans 53,8 % des cas. Les lesions glomerulaires representaient 80 % des cas, les lesions tubulo-interstitielles 7 % des cas, les lesions vasculaires 10,36 % des cas, et les lesions inclassees 2,64 %. Parmi les lesions glomerulaires, la hyalinose segmentaire et focal (HSF) representait 43,3 % des cas, la glomerulonephrite extra-membraneuse (GEM) 11,6 % des cas, la lesion glomerulaire minime (LGM) 35,5 % des cas, la glomerulonephrite membranoproliferative (GNMP) 2 % des cas, la glomerulonephrite extra-capillaire (GNEC) 2,3 % des cas, la glomerulonephrite aigue (GNA) 1,6 % des cas et un cas de nephropathie a IgA. Les nephropathies etaient primitives dans 311 cas (63,22 %) et secondaires dans 181 cas (36,78 %). La nephropathie lupique representait 17,13 % des nephropathies secondaires. Discussion Les nephropathies biopsiees au Senegal sont dominees, comme partout ailleurs, par les nephropathies glomerulaires. Parmi ceux-ci, la HSF reste la lesion histologique la plus frequente sur l’ensemble des biopsies effectuees. Conclusion La PBR est souvent indispensable pour orienter le diagnostic des nephropathies et aider a la prise de decision therapeutique. L’encouragement de sa pratique en Afrique subsaharienne permettra de mieux connaitre les nephropathies dans cette region.

The ABO, MN, Rh (CDE), P, Kell, Duffy and Gm groups and the haemoglobins are studied in three West African Populations (213 Coniagui, 147 Bassari, 165 Badik for the ABO system ; 54 Coniagui, 147 Bassari, 164 Badik for the remaining groups). The first results published in this preliminary paper give some informations about the differences existing between these three populations, geographically close. They constitute the beginning of a larger sero-anthropological survey, on demographic and genealogical basis, which aims the description of the different populations living in the « Departement de Kédougou » (Senegal Oriental) and no definite conclusion is given. The paper ends by an account of the technics used in the samples collection and of the difficulties encountered in a tropical area. BULL. ET MÉM. SOCIÉTÉ ANTHBOP. DE PARIS, T. 8, 11e SÉRIE, 1965. 2, Les groupes ABO, MN, Rh (CDE), P, Kell, Duffy, Gm et les hémoglobines sont étudiés pour trois populations ouest africaines (213 Coniagui, 147 Bassari, 165 Badik pour le groupe ABO ; 54 Coniagui, 147 Bassari, 164 Badik pour les autres groupes). Les premiers résultats publiés dans cet article préliminaire donnent quelques indications sur les différences existant entre ces trois populations géographiquement voisines. Ils ne constituent que le début d'une enquête séro-anthropolo- gique plus vaste, à base démographique et généalogique, qui doit aboutir à la description des différentes populations vivant dans le Département de Kédougou (Sénégal Oriental) et aucune conclusion définitive n'est donnée. L'article se termine par un compte rendu détaillé des techniques de récolte et des difficultés rencontrées en zone tropicale., Gessain Robert, Ruffié Jacques, Kane Yaya, Kane O., Cabannes R., Gomila J. Note sur la séro-anthropologie de trois populations de Guinée et du Sénégal : Coniagui, Bassari et Bedik (groupes ABO, MN, Rh, P, Kell, Gm et hémoglobines).. In: Cahiers du Centre de recherches anthropologiques, XI° Série. Tome 8 fascicule 1-2, 1965. pp. 5-18.

Kane Yaya, Ruffié Jacques. Étude hémotypologique de quelques groupes Peul, Toucouleur, Ouoloff et Sérère du Sénégal occidental.. In: Bulletins et Mémoires de la Société d'anthropologie de Paris, XI° Série. Tome 4 fascicule 3, 1963. pp. 545-553.