肾脏病学与治疗学杂志

Introduction: Tuberculosis (TB) is common in patients with chronic renal failure due to their immunosuppressed state. Diagnosing TB is difficult because of the latency of the clinical and biological picture. This study was conducted to assess the performance of the Interferon Gamma Released Assay (IGRA) in the diagnosis of latent TB infection in chronic dialysis patients in Senegal. Materials and methods: This is a cross-sectional study carried out in Nephrology Department of Aristide Le Dantec University Hospital during 6 month. All patients with chronic haemodialysis or chronic peritoneal dialysis were included. A group of patients with non-dialyzed kidney disease was also included. Patients with active TB at the time of the study were not included. A tuberculin skin test (TST) and an IGRA were performed. The QuantiFERON® (QFT) was repeated 3 months later in the group of dialysis patients. Results: Sixty-two patients were included: 22 haemodialysis (HD) patients, 19 peritoneal dialysis (PD) patients and 21 patients with non-dialyzed kidney disease (NDKD). The mean age was 44 ± 12 years with a sex ratio M/F of 1.06. Nineteen patients were vaccinated with BCG. TST was positive in 22 patients (35.4%). Subjects with a positive TST had a significantly higher rate of BCG vaccination (P=0.002) than those with a negative TST. QFT was positive in 17 patients (28%) and undetermined in 9 patients (14%). In patients with a positive QFT, six (27%) were in HD, four (21%) in peritoneal dialysis and seven (33%) in NDKD. A total of 9/17 (52%) QFT-positive patients developed active TB. Correlation (r=0.998, p=0.001) indicates that T cell functionality was not affected by the duration of renal replacement therapy. Conclusion: These results highlight the advantage of Quantiferon test over TST for diagnosis of latent TB in immunocompromised patients, including chronic dialysis patients.

Objective: To describe the situations of discovery of CKD (CKD) in Togo.

Patients and methods: This was a cross-sectional and descriptive study conducted in the nephrology department of Sylvanus Olympio University teaching hospital (Lomé). This study was conducted from January 1st, 2017 to December 31st, 2018 for patients with CKD.

Results: The mean age was 44.08 years old with extreme ages of 18 to 71 years and a sex ratio of 1.56. The majority of patients came from urban areas in 68% of cases. The main antecedents were dominated by traditional medication in 69.5% of cases, followed by hypertension in 66.1% of cases. One hundred patients (84.7%) out of the 118 enrolled were referred from a health facility. Of these referred patients, 78% came from a public health center and 16% from private centers. University hospitals are at the forefront of referral centers with 30% of cases. The clinical manifestation at admission was dominated by edema (35.2%), dyspnea (33.9%) and hypertension (11.5%). 93.2% of patients were in stage 5 of CKD at admission.

Conclusion: CKD is a reason for hospitalization quite frequent in our service. His prognosis is redoubtable. Emphasis must be placed on better distribution of health human resources in the diagnosis and monitoring of CKD.

Background: The deterioration of nephrons at an advanced stage of renal disease results to chronic dysfunction of the kidneys, which requires either dialysis treatment or renal transplant. The need to enhance the clearance of byproducts of metabolism from the body during haemodialysis spurred the study.

Purpose: To determine Responses of Urea, Creatinine and Uric Acid to Soft Tissue and Passive Mobilization in Patients with Renal Diseases Undergoing Haemodialysis.

Method: This study is a randomized controlled clinical trial. The total of 33 participants (23 males and 10 females) was involved in the study. The participants were randomly and consecutively assigned into two groups as they register for haemodialysis. The treatment group (n=16) received the soft tissue and passive mobilisation prior to haemodialysis. The control group (n=17) had only haemodialysis. In each group, the pre and post-dialysis blood samples for determination of plasma concentration of urea, creatinine and uric acid were taken. Data collected were subjected to descriptive statistics, and analyzed using independent t-test. Probability value less than 0.05 was considered statistically significant. SPSS version 17 was used.

Result: The results showed that soft tissue and passive mobilisation clinically enhances the reduction (p<0.05) of the plasma concentration of creatinine and uric acid after haemodialysis in patients with renal disease. However, there was no significant reduction (p>0.05) in the plasma concentration of urea compare to the control, probably due to low molecular weight of urea.

Conclusion: Soft tissue and passive mobilization enhances fluid kinetics, dislodges metabolites, especially those of high molecular weight such as uric acid, in the interstitial spaces and mobilizes them into the blood stream for clearance.

Implication: Soft tissue and passive mobilization could be utilized as an adjunct to haemodialysis in the clearance of by-products of metabolism in relevant patients.

Background: Hepatitis B virus (HBV) infection and chronic kidney disease (CKD) are major public health issue. Patients with HVB are at risk of CKD. Data on the prevalence of CKD in HBV-infected patients in Sub Saharan Africa (SSA) are inexistent. This study aimed to determine the prevalence and associated factors of CKD in HBV-infected patients in Cameroon.

Methods: We carried out a cross sectional study from March to August 2017 in Cameroon, including consenting patients aged >18 years followed up for chronic HBV. Data collected in medical records were: Socio demographic, Comorbidities, HBV-related data and biological data. Morning urine and blood were collected for dipstick analysis and creatinine dosage. GFR was estimated using the four-variable MDRD and CKD-EPI equations. Patients with eGFR<60 ml/min/1.73 m² and/or urinary abnormalities underwent a second measurement 3 months later. Definition and classification of CKD were based on the KDIGO 2012. Logistic regression was used to determine factors associated to proteinuria and CKD. A p value <0.05 was considered significant.

Results: We included 272 participants, mean age of 37.33 ± 9.73 years, 65.8% males. Prevalence of proteinuria was 12.1%, 7.7% for haematuria and 3.7% for leucocyturia. Prevalence of CKD was 19.9% (54/272) using CKDEPI- formula and 18.4% (50/272) with MDRD, with 8.1% (22/272) at CKD stage 1, 8.9% (24/272) for stage 2, 2.6% (7/272) stage 3, 0.3% (1/272) stage 4. Factors associated to proteinuria were chronic use of herbal medicine (p=0.007), haematuria (p=0.009), while age ≥50 years (p=0.004), duration of HBV infection ≥5 years (p=0.039) and chronic use of herbal medicine (p=0.040), were factors associated to CKD.

Conclusion: CKD is frequent amongst HBV patients in Cameroon. Older age, used of traditional herbs and longer duration of the infection were factors associated to CKD. There is need for renal function evaluation during follow up of HBV infected patient in our setting.