腎臓学と治療学ジャーナル

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.

Objectives: To determine the frequency of the chronic kidney failure (CKF) in people living with HIV (PLHIV) on antiretroviral treatment (ART) and to identify associated factors.

Methods: This cross-sectional, descriptive and analytical study, conducted in the Outpatient Centre of PLHIV in the National Teaching Hospital of Cotonou from April to July of 2013. Were included, PLHIV aged over 16 years, taking ART for at least three months and having in their file, creatinine at ART initiation. Creatinine was performed at inclusion in the study. Proteinuria was sought on the strip. Chronic kidney failure was defined as creatinine clearance calculated according to Cockcroft-Gault less than 60mL/min for at least 3 months. Factors associated were searched by logistic regression univariate and multivariate analysis. Confidence intervals were calculated at 95% and alpha level was 5%.

Results: A total of 480 patients participated in the study (73.3% women; mean age 41.4 ± 9.16 years, in school: 64.6%). The prevalence of chronic kidney failure was 18.7%. The main factors associated in univariate analysis were age (p<0.001), BMI (p<0.001), educational level (p=0.03), the exposure time to ART (p<0.001) and the loss of kidney function at the initiation of ART (p<0.001); in multivariate analysis: age (p<0.001), sex (p<0.001), the body mass index (p<0.001), the loss of kidney function at ART initiation (p=0.034) and didanosine (p=0.007).

Discussion and Conclusion: The prevalence of chronic kidney failure in patients receiving ART is high. The creatinine serum in biological monitoring in the ART or better to determine the glomerular filtration rate among PLHIV at least every six (6) months remains a necessity.

Legionnaires’ disease is an important cause of community-acquired pneumonia. Although uncommon, disease outbreaks of public health significance still happen nowadays. Several outbreaks have been occurred in various European countries but the most recent one occurred in Portugal. It was one of the largest of the world and began in November 2014 in Lisbon. We know that mortality might be higher in people who have pre-existing medical conditions. The chronic kidney disease population is predisposed to adverse infectious events but it’s not considered up to this moment a main risk factor or of bad prognostic to the Legionella infection. The authors present a case report of a sporadic smoker young patient with chronic kidney disease who had a catastrophic presentation of Legionella Pneumophila infection requiring simultaneous use of two extracorporeal techniques.

Introduction: Since 1989 when Kusunoki et al. described C4d renal deposits in native idiopathic membranous nephropathy (nIMN) their role in disease progression has not been clarified yet. Recent studies have identified C4d glomerular staining as a marker of negative progression of renal function in a primary glomerular disease like IgA nephropathy. We have retrospectively analysed 15 consecutive formalin-fixed paraffin-embedded kidney biopsies from patients with nIMN (7F, 8M) performed in our Unit from October 1995 to February 2011.

Methods: Kidney sections were stained using polyclonal rabbit IgG anti-human C4d antibodies. Normal renal tissue was obtained from heart-beating braindead donors before kidney harvesting. Positive control biopsy was a humoral kidney rejection with intense C4d staining. Data are expressed as M ± SD.

Results: Ten (5F, 5M) of 15 nIMN kidney biopsies showed global and diffuse C4d glomerular capillary staining (C4d+). At 6-month follow-up (C4d+ 31 ± 26 months, C4d– 29 ± 31 months; P = NS) we observed a significantly higher 24-hour urinary protein excretion rate (UPr) in C4d+ (P = 0.0051 vs. C4d–), and a significantly lower MDRD eGFR (P = 0.0337 vs. C4d– at diagnosis) when compared with data at disease presentation.

Conclusion: Our data suggest that C4d glomerular capillary deposits in nIMN with a follow-up longer than 6 months might be a negative prognostic factor for both UPr and eGFR. We are aware that our study has limitations like the relatively short term follow-up and the little number of biopsy analysed. Nevertheless, the association between increasing UPr, worsening of renal function and glomerular deposits of C4d in nIMN patients might deserve reporting and eventually confermation by further investigations.

Objective: To evaluate Hb outcomes in patients with dialysis-dependent or non-dialysis dependent chronic kidney disease (CKD) receiving continuous erythropoietin receptor activator (C.E.R.A.) therapy under routine conditions at specialist nephrology centers in Germany.

Methods: In a 12-month, prospective, observational, multicenter study, Hb outcomes were assessed in 1,580 patients with CKD (1,184 dialysis-dependent, 326 non-dialysis dependent) given once-monthly C.E.R.A. under routine conditions.

Results: Across the total study population, mean hemoglobin was in the range 11.4–11.6 g/dL at all post-baseline visits. In the 962 patients on hemodialysis who were pretreated with ESA including C.E.R.A., mean (SD) hemoglobin was 11.4 (1.2) g/dL at baseline and 11.5 (1.1) g/dL at month 12; the mean (SD) number of C.E.R.A. dose changes was 3.0 (2.4). For the 227 non-dialysis dependent patients without prior ESA therapy, mean hemoglobin values were 10.6 (1.1) g/dL at baseline and 11.6 (1.3) g/dL at month 12, with a mean of 1.0 (1.4) dose changes. Presence of diabetic nephropathy showed no clinically relevant effect on hemoglobin response in either group. Overall, the proportion of patients with every hemoglobin measurement within narrow (≤ 2 g/dL) pre-specified ranges was low (<10%), but higher for the range 10.0–13.0 g/dL (28.7%), reflecting the known fluctuation in hemoglobin values over time. Patients managed at large centers were more likely to have hemoglobin range in the range 10–13 g/dL throughout the 12-month study, suggesting closer anemia management. In total, five patients (0.3%) discontinued C.E.R.A. due to adverse events.

Conclusion: Switching dialysis-dependent patients from more frequent ESA regimens to once-monthly C.E.R.A. therapy or initiating once-monthly C.E.R.A. de novo in predialysis CKD patients appears to be an effective therapeutic strategy regardless of diabetic status.