腎臓学と治療学ジャーナル

Background: Chronic Kidney Disease has been simplified over the last 5 years. Chronic Kidney Disease (CKD) is defined as kidney damage or glomerular filtration rate (GFR) <60 ml/min/1.73 m² for more than 3 months with implications for health. The prevalence rates of CKD worldwide are high and have increased in the last few years to about 13% -15%, with an increased prevalence of diabetes and hypertension which shows it is becoming one of the public health problems.
Objective: To assess the magnitude Chronic Kidney Disease and its associated factors among patients at Zewditu Memorial hospital.
Methodology: This study was done by an institutional based cross sectional study.
Results: A total of 320 individuals were participating on the study. The response rate of 320 (100%). The participants, of whom 151 (47.2%) were males and 169 (52.8%) were females. The mean age (± standard deviation) of the participants was 40.1 (± 14.6) years and 128 (40%) were in the age range of 19-35 years.
Conclusion and recommendations: The magnitude of CKD in this study inveterate, that the disease become abundant and need attention. Facing this, we restate the need to aware by health professionals in improvement of primary care treatment and follow-up of patients with hypertension and any kind of kidney infection.

Aims: Investigating the thiol-disulphide balance in the patients with acute renal failure and evaluating the potential of using tGFR (thiol based GFR) index as a new parameter, alternative to the parameter called estimated Glomerular Filtration Rate (eGFR).
Study design: The serum thiol-disulphide levels in the predialysis and postdialysis blood samples of 42 patients diagnosed with acute renal failure in the emergency department and hemodialyzed right after were measured through the novel method. Methods: The acute renal failure was detected through the clinical and laboratory findings, and a hemodialysis procedure was performed. The obtained results were statistically evaluated. While eGFR (ml/min/1.73 m2) values were being calculated, MDRD (Modification of Diet in Renal Disease) formula was used. To calculate tGFR as an alternative to eGFR, tGFR=(SH/creatinine) xk formula was used.
Results: Disulphides/native thiol and Disulphides/total thiol rates in the patient population were found to be significantly lower after the hemodialysis when compared with those before the hemodialysis process (p<0.001). A significantly negative relationship was found between the creatinine values and the native and total thiol values (r=-0.732; r=-0.739; p<0.001 respectively). There was also a significantly negative relationship between the urea values and the native and total thiol values (r=-0.722; r=-0.739; p<0.001 respectively). Quite a significant relationship was also found between eGFR values and tGFR values (r=0.98; p<0.001).
Conclusion: The thiol-disulphide balance in the patients with acute renal failure weakened, in addition to which the balance in question shifted towards the direction of disulphide. Native thiol and total thiol levels are associated with the severity of the disease. There is the potential of using tGFR index as an alternative to eGFR for the emergency department patients (ER-patients) whose age, gender and race cannot be identified.

Despite the numerous advances in hemodialysis practice, cases of CTS are still observed in our patients. The aim of this study was to assess the prevalence of CTS and factors associated to its occurrence in our chronic HD patients.
Methods: We performed a cross-sectional study in December 2017, including consenting chronic hemodialysis patients, with a dialysis vintage of at least three months, in a reference state center in Oujda- Eastern Morocco. Diagnosis was based on signs and symptoms reported by the patient, and manoeuvres of Tinel and Phalen. Symptomatic patients underwent electromyography (EMG) on non-dialysis days, by the same neurologist in the same conditions.
Results: Our study included 112 chronic HD patients, who met the inclusion criteria. CTS was diagnosed and verified using nerve conduction examination in 8.04% of the patients. Diabetic nephropathy was the most observed initial nephropathy in CTS patients in 36.3% of the cases. Patients with CTS were older (mean age: 52.99 ± 11.32 vs. 48.4 ± 12.6; p=0.002), mainly males (63.6% vs. 55.4%; p=0.03), active smokers in 18.5% of the cases. They also had a longer HD duration (95.8 ± 15.75 vs. 82.11 ± 17.22 months; P<0.001). Moreover, CTS patients had higher diabetes mellitus prevalence (36.3% vs. 13.8%; p<0.001), higher HCV prevalence (18.18% vs. 2.97%; p=0.02), and were less likely to have a urine output >100 ml/day (27.2% vs. 3.98%; P=0.003). Multivariate logistic regression showed that HCV (OR: 1.45, 95% confidence interval (CI): 1.17-1.87, p=0.034), HD vintage [OR: 1.95, 95% CI: 1.89-3.65, P<0.001] and urin output <100ml/day (OR:1.72, 95% CI: 1.03-2.57, P=0.01) were positively associated with CTS.
Conclusion: In this cross-sectional study, we observed that a long dialysis vintage, positive HCV and loss of residual renal function were associated with CTS in chronic HD patients. However, additional studies are required for further clarification of the pathogenesis of CTS in chronic HD patients.

The case study describes the admission of a 17 years old patient in the emergency department of Constanta with main complaints: diffuse abdominal pain, poly arthralgia and intense headache. The first screening tests revealed anaemia, renal impairment associated with nephritic syndrome. In the immunological investigations, the level of antibodies anti-ds DNA was increased and the following renal biopsy presented segmental changes of the glomerular membranes. The clinical features associated with the laboratory results were specific for the diagnosis of systemic lupus erythematosus. The patient was continuously under follow-up and was given mainly antihypertensive drugs and corticosteroids. She also received treatment for correction of anaemia and analgesia. In conclusion, this patient with a newly diagnosed autoimmune disorder was presented with deteriorating renal function associated with hypertension, conditions which appear very rarely in patients of such a young age.