Ultrafiltration (UF) Effectiveness on intradialytic hypertension (IDH) in chronic hemodialysed patients in a nephrology unit in Dakar: UF-IDH clinical trial
Introduction Progressive ultrafiltration (UF) could improve IDH. The aim of this work was to evaluate the effectiveness of progressive UF in the management of IDH. Methods This randomized clinical trial in two groups: interventional group A (UF, n = 12) and control group B (n = 12), was conducted in chronic hemodialysis patients with IDH. A first phase of cross-sectional collection of BP before and after dialysis, during 2 weeks, made it possible to obtain this cohort of 24 patients. A progressive decrease in basal weight of 0.25 kg per session as a function of hemodynamic tolerance was achieved in group A. The primary endpoint, the proportion of patients with disappearance of IDH, was assessed at baseline end of the 4th and 8th week. Results At the 4th week, the IDH disappeared in 83.3% and 41.7% of the patients of the group A and B respectively with a hazard ratio (HR) at 0.29; IC 95 = [0.14-0.59]; p = 0.035. At the 8th week, the IDH was missing in 72.7% and 66.7% of the patients of the group A and B respectively with a HR at 0.76; IC 95 = [0.58-1.00]; p = 0.75. In addition, the decrease in basal weight was associated with the occurrence of side effects (p = 0.0001) with a HR of 5 [1.45-7.27]. UF discontinuation was required in 4 patients in group A (36.4%). Conclusion Progressive UF was associated with a significant reduction in the prevalence of IDH in our patients at week 4.
Intrinsic factors affecting incidence of urolithiasis in diabetic patients –A preliminary case-control study
There has been a steep rise in incidence of urolithiasis in recent years. Recent studies have revealed an increased prevalence of urolithiasis in patients with Diabetes Mellitus (DM). The role of various intrinsic factors of diabetic patients such as Body Mass Index (BMI), level of glycemic control, baseline kidney function and mode of treatment of DM which can influence incidence of urolithiasis still remains uninvestigated. This case control study was taken up to evaluate these intrinsic factors affecting the incidence of urolithiasis in patients with DM. The case group included diabetic patients with urolithiasis and the control group included age matched diabetic patients without urolithiasis. We concluded that Higher BMI and higher serum creatinine level in diabetic patients were associated with increased incidence of urolithiasis whereas other intrinsic factors such as age, sex, duration of DM and the level of glycemic control did not have any influence on it.
Accuracy of Prostate Specific Antigen Density in Predicting Prostate Cancer- A single-centre UK experience
Introduction and objectives: PSA has been a useful tool in identifying prostate cancer since its discovery. However relying on this alone can lead to unnecessary over investigation as it can be falsely raised in other conditions. PSA density is a possible enhanced marker for prostate biopsy indication, however it is not standard practice or recommended in national guidelines. Previous studies have shown that PSA density is most useful when the PSA is in the range of 4-10. We aim to study the effectiveness of PSA density at detecting prostate cancer within that range as well as outside that range. Methods: Retrospective single centre study at Peterborough City Hospital including 500 patients who had a MRI prior to prostate biopsy between July 2017 to July 2018. Patients undergoing repeat biopsy already on a cancer pathway were excluded. PSA density was calculated by dividing PSA from the prostate volume recorded on the MRI. A cut of value of PSA density was chosen at 0.15 and 0.10. Results: Data from 500 patients with a mean age of 65 and mean PSA of 10.7 (PSA range 0.32 to 99). 251 (50.2%) patients had cancer on histology with 152 having clinically significant cancer. Mean PSA density was 0.11ng/ml/cm3 with benign histology, 0.36ng/ml/cm3 for all cancer and 0.48ng/ml/cm3 for clinically significant cancer. Overall the mean PSA density in prostate cancer was found to be 0.15. Sensitivity of PSAD at detecting all prostate cancer at cutoff of 0.10 with PSA 4-10 was 76% and 88% for clinically significant prostate cancer (Gleason 7>). The negative predictive value was 94% for clinically significant prostate cancer. With PSA of 10 and PSA density of 0.10 the sensitivity was 93% (all cancer) and 96.6% (Gleason 7>) with a negative predictive value of 93.7% for clinically significant prostate cancer. At a cut…
Heat Stress Nephropathy and Cardiovascular Surgery-Associated Renal Failure: Similarities and Implications
Climate changes associated with global warming are producing challenges increasingly relevant to clinicians. Rising temperatures and extended heat waves are associated with a growing incidence of a recently described condition termed heat sensitivity nephropathy. Considering all causes of acute kidney injury and chronic kidney disease, those producing renal dysfunction consequent to cardiovascular surgery may most closely overlap those tied to kidney disease following excessive chronic or acute heat exposure. In this review, heat sensitivity nephropathy and cardiovascular surgery related renal injury are characterized and compared. While both are global in distribution, the former has highest prevalence in remote, rural areas and difficult to study and quantify. Renal injury following cardiovascular surgery, occurring by contrast in relatively controlled settings, is more amenable to evaluation of diagnostic approaches, prognostic indicators, and potential treatments. Such findings may ultimately apply not only to surgically-related kidney damage but to heat sensitivity nephropathy as well. Despite many studies addressing post-cardiovascular surgery renal failure, no single management method has emerged as definitively superior. Nonetheless, reasonably standardized worldwide conduct of cardiac and vascular surgery provides fertile conditions for research that could lead to improved diagnostic and therapeutic approaches. Such findings may ultimately apply to not only surgically-related renal injury but perhaps also to heat sensitivity nephropathy. Instead of anticipating discovery of major isolated preventative or treatment methods applicable to either cause of renal failure, it is more realistic that a series of marginally successful measures employed in combination will engender the most nearterm progress. Potentially complimenting currently available options is biomarker analysis that may better guide both renal injury diagnosis and treatment efficacy assessment.
Relevance. The reason for this study was the discovery of patients with clinical and laboratory manifestations of chronic kidney disease (CKD) in the lumen of the tubules of red blood cells and their decay products during nephrobiopsy1. It is known that the appearance of glucose in urine makes an ideal nutrient base for microorganisms that provoke chronic microbial inflammatory damage to the kidneys. Glycated hemoglobin is included in 5% of red blood cells in healthy adults. Its increase is associated with episodes of glycemia exceeding 6.5 mmol/l. which occuts in diabetes decompensation. Moreover, glycated hemoglobin has toxic properties with respect to the viability of the surrounding cytomembranes. This explains the large number of multiple organ diabetic complications 2,3. At the same time, it was found that the biochemical process of glycation of not only hemoglobin, but also other cellular glucoproteins is accompanied by oxidative damage to cytomembranes leading to their structural and functional failure 4,5. However, the role of glycated hemoglobin and glucose released during the deteriation of erythrocytes in the renal tubules, as one of the possible pathogenetic factors in the occurrence of chronic kidney disease, no one has previously analyzed.
Hepatitis C positive donor kidney transplants to decrease wait time for kidney recipients: Review of data and recent trials
A kidney transplant is superior to dialysis for patients with end-stage renal disease. The increasing number of end-stage renal disease patients and limited number of available donor kidneys have led to long waiting times to receive a life-saving kidney transplant. Approximately, 14% of the patients wait for more than five years to receive a kidney transplant. The risk of death and becoming too sick to receive a transplant while on the waitlist poses another healthcare challenge. About 21% of the patients are removed from the waitlist every year without receiving a kidney transplant. Over time many strategies are being proposed and used to eliminate the shortage of kidney organs. The advent of the novel therapy for HCV infection and the increasing number of HCV infected donor kidneys due to the unfortunate opioid epidemic has provided new opportunities for kidney recipients. More than 500 high-quality HCV positive donor kidneys are discarded every year. The recent trials of HCV positive donor kidney transplants to HCV negative recipients followed by successful HCV treatment are very motivating. The studies have illustrated that the quality of HCV positive donor kidneys are very similar or even better than HCV negative donor kidneys. HCV positive donor kidney transplants will shorten wait-time for kidney transplant recipients and save lives.
Hemodialysis in Emergency Situation: About 107 Cases at The Hemodialysis Center of Thies Hospital (Senegal)
INTRODUCTION: The gaol of this work was to determine the hemodialysis’ prevalence in emergency situations, indications, clinical, paraclinical, evolutionary and patient future. PATIENTS AND METHODS: It was a prospective monocentric descriptive and analytical study over a period of one year (01 March 2018 to 30 April 2019) carried out at the regional hospital of Thiès. Was included all patients with acute or chronic renal failure who were under emergency hemodialysis sessions. RESULTS: Out of 263 patients, 107 patients underwent emergency hemodialysis with a prevalence of 40.68%. The average age of our patients was 46.39 ± 17.13 years and the sex ratio was 1.05. The main indications for emergency hemodialysis were poorly tolerated uremia in 54 patients (50.47%) followed by hyperkalemia in 43 patients (40.19%). Chronic renal failure (CRF) was the most noted type of renal disease in 74 patients (69.15%) with nephroangiosclerosis as the primary cause (25.2%). Acute renal failure (ARF) was found in 33 patients (38.85%) with acute tubular necrosis (10.8%) as the main etiology. The most frequently used approach was the femoral route in 87 patients (81.3%). Nineteen patients (17.8%) died including 13 patients outside dialysis and 6 patients on dialysis. CONCLUSION: In Senegal, patients are seen most often in the late stages and the inaccessibility to treatment of extra-renal treatment make that the hemodialysis is most often started in a context of urgency.
Hemodialysis in emergency situation in a Hemodialysis Center in Dakar : A prospective study about 81 cases
Introduction: Hemodialysis is a renal replacement technique that uses extracorporeal blood circulation (ECC) to purge the blood of patients with renal failure. It is used urgently in severe acute kidney injury (AKI) and complicated end stage renal disease (ESRD). The objective of this work was to determine the prevalence of each indication of emergency hemodialysis and its prognosis. Methods: We conducted a prospective, mono-centric study of descriptive and analytical type over a period of 6 months at the hemodialysis center of Aristide Le Dantec University Hospital. All patients with acute or chronic renal failure who underwent hemodialysis during an emergency were included. These emergencies were for the AKI or Chronic Kidney disease (CKD) the existence of one or more severity criteria: pulmonary œdema, hyperkalemia, severe metabolic acidosis, poorly tolerated uremia, persistent anuria and / or symptomatic hyponatraemia. Results: Eighty-one emergency hemodialysis patients were received during the study period out of a total of 660 hemodialysis patients serving a hospital prevalence of 12.2%. The mean age of the patients was 39.31 ± 18.78 years with a sex ratio of 1.02. The first indication of emergency hemodialysis was poorly tolerated uremia in 46 patients (56.7%) followed by threatening hyperkalemia with 43.2%. The evolution was highlighted by a complete recovery in 53% of patients with AKI whereas for patients with ESRD lifting the emergency was the rule. Fifteen patients (18.50%) had died, including 12 patients (14.80%) outside dialysis and 3 patients (3.75%) on dialysis. The occurrence of death was statistically correlated with hyperkalemia (p = 0.003) and metabolic acidosis (p = 0.001). Conclusion: Hemodialysis was performed urgently in 12.2% of cases. Poorly tolerated urine was the most common indication (56.7%). In the majority of cases we noted a good evolution with the emergency lifting. However we noted 15 deaths (18.5%).
UTIs are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. If left untreated, a urinary tract infection can have serious consequences. Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode of UTI during their lifetime. Uncomplicated lower UTI remains one of the most commonly treated infections in primary care. A complicated UTI is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease. Diagnosis of a UTI is based on a focused history, with appropriate investigations depending on individual risk factors. The paper reviews several chronic conditions that are risk factors for UTIs in human being.
Impact of components of metabolic syndrome on the prostatic volume and lower urinary tract symptoms in a sample of patient with benign prostatic hyperplasia in Iraq
Objective To evaluate the association between the components of metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) focusing at their effects on prostatic volume and on the severity of LUTS . Patients & Methods From October 2016 to January 2018, eighty patients presented with LUTS due to the BPH. LUTS were assessed using the international prostatic symptoms score (IPSS) and MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III guidelines. Patients were randomly collected into two categories: A (48 patients) had MetS and B (32 patients) without MetS. Results The mean age was 64.3 years, statistically significant variation was identified between the two categories regarding the moderate and severe IPSS, S.PSA, prostatic size and post voiding residue (PVR), the P value (