Current Issue : July-September Volume : 2025 Issue Number : 3 Articles : 5 Articles
Background and Objectives: The development of acute kidney injury (AKI) in the post-cardiopulmonary resuscitation (post-CPR) period is a common pathology that has not been adequately investigated but contributes significantly to morbidity and mortality. We aimed to investigate the causes of AKI in the early post-CPR period. Materials and Methods: This study was performed retrospectively in 82 adult patients who survived for at least 2 days out of 312 patients admitted to the intensive care unit after cardiac arrest in 2013–2022. AKI developed in 40 (48.7%) of these 82 patients (AKI 1–3 patient, respectively: 14, 13, 13). Binary logistic regression analysis was performed separately to determine the risk factors for AKI and mortality. Results: Each unit increase in BMI increased the risk of developing AKI by 1.272-fold, and the increase was statistically significant [OR (95%CI) = 1.272 (1.089–1486); p = 0.002]. The use of VSP and INO treatment alone increased the risk of AKI by approximately 14-fold, and this increase was statistically significant [OR (95%CI) = 14.225 (1.172–172.669); p = 0.037]. The combined use of VSP and INO treatment increased the risk of AKI by approximately 42-fold, and this increase was statistically significant [OR (95%CI) = 42.089 (2.683–660.201); p = 0.008]. The COVID-19 period alone increased the risk of developing AKI by 2.8-fold compared to the non-COVID-19 period, but the statistical significance of this increase was limited [OR (95%CI) = 2.801 (0.859–9.126); p = 0.088]. The development of AKI was not associated with mortality [OR (95%CI) = 2.194 (0.700–6.872); p = 0.178]. Conclusions: Having VSP and/or INO support and high BMI in the post-CPR period are the most important reasons for the development of AKI. COVID-19 may also increase the risk of developing AKI....
Background and Objectives: This study evaluated the safety and efficacy of longterm indwelling self-expandable covered metallic stents (UVENTA; Taewoong Medical Co., Ltd., Seoul, Republic of Korea) used to manage benign and malignant ureteral strictures. Materials and Methods: We retrospectively identified and analyzed the medical records of all patients who underwent metallic stent insertion at our institution since September 2012. Additionally, we evaluated the technical and clinical success rates and complications of patients who underwent follow-up for more than 36 months. Results: A total of 25 patients underwent metallic stent insertion for ureteral obstructions at our institution. Among them, 18 underwent follow-up for more than 36 months. A total of 21 ureters (15 unilateral and 3 bilateral) were ultimately included in this study. Metallic stents were successfully placed in all ureters using a retrograde approach, with a technical success rate of 100%. The mean follow-up duration was 58.6 months (range, 36–107 months). However, the clinical success rates were 85.7% (18/21 ureters) by 12 months, 61.9% (14/21 ureters) by 24 months, and 52.4% (11/21 ureters) after 36 months. During follow-up, obstructions could not be resolved using metallic stents in eleven ureters (median time to failure, 18.4 months; range, 2−40 months); therefore, they were treated with nephrectomy (three ureters because of a nonfunctional kidney) or percutaneous nephrostomy and double J stent placement (four ureters). Major complications included the encrustation of the metallic stent, flank pain, and gross hematuria. A uretero-enteric fistula occurred in one ureter. In two patients, existing metallic stents were removed and patency was maintained. In another two patients, new metallic stents were inserted without complications. Conclusions: Benign and malignant ureteral obstructions may be treated effectively and safely with metallic stents. However, the patency rate drastically decreased and major complications occurred during long-term follow-up. Therefore, careful patient selection is necessary to achieve better results....
Background: Renal manifestations, including glomerular hyperfiltration during sickle cell disease (SCD), are very frequent and constitute the starting point for renal failure. Few data are available on this subject in Togo. The aim of this study was to describe the predictive factors of glomerular hyperfiltration in SCD in our Togolese context. Methods: This was a retrospective descriptive and analytical study carried out at the Centre National de Recherche et de Soins aux Drépanocytaires du Togo located in the commune of Lomé. Hyperfiltration was defined for all major sickle cell patients by a glomerular filtration rate (GFR) > 130 ml/min/1.73m2 and renal failure by a GFR < 60 ml/min/1.73m2 calculated according to the Modification of Diet in Renal Disease (MDRD) equation. We investigated factors associated with glomerular hyperfiltration using univariate and multivariate logistic regression. The dependent variable was GFR status > 130 coded 1 and 0 if not. Results: 82.0% of major sickle cell patients had glomerular hyperfiltration, and 1.7% were in renal failure. The mean age of our patients was 14.1 years, with a female predominance of 53.2%, giving a sex ratio (M/F) of 0.88. Homozygous sickle cell patients represented 55.3% of the population and heterozygous SC 38.5%. In a comparative analysis, there was a statistically significant difference between the proportion of patients with and without glomerular hyperfiltration according to age (p < 0.001), gender (p < 0.001), economic activity (p < 0.001), marital status (p < 0.001), educational level (p = 0.007), hemoglobin phenotype (p < 0.001), proportion of HbS (p < 0.001); to certain circumstances of discovery as painful crises (p = 0.002), infection (p < 0.001), hand-foot syndrome (p = 0.015) and asthenia (p = 0.032); of certain complications as occurrence of at least one complication (p = 0.025), anemia (p = 0.003), priapism (p = 0.048), renal fail-ure (p = 0.001), osteonecrosis (p = 0.041) and retinopathy (p = 0.001). Risk factors for hyperfiltration were male gender (p = 0.016), age under 10 years (p = 0.001), age between 10 and 19 years (p < 0.001), hemoglobin S > 70% (p = 0.009) and low azotemia (p = 0.004). Conclusion: Glomerular hyperfiltration is very frequent in sickle cell disease syndromes in Togo, with a non-negligible presence of renal failure. Risk factors are dominated by a young age, as in the literature....
Background: High blood pressure is a major cardiovascular risk factor in the development of stroke, heart failure, coronary heart disease and renal insufficiency (RF). In Togo, hypertension was cited as the leading cause of chronic kidney diseases (CKD) in a study carried out in the nephrology department. Objectives: The overall objective was to determine predictive factors RF in hypertensive patients. Material and Methods: We carried out an analytical and comparative study. Included in the study were all medical records of hypertensive patients who had been consulted or hospitalized in the cardiology department from January 2015 to December 2020 and who had undergone a renal workup. RF was defined for all patients by a GFR < 60 ml/min/1.73m2 calculated according to the MDRD formula. Risk factors associated with renal failure in hypertension were assessed using univariate and multivariate logistic regression. The dependent variable was GFR status, coded 1 if GFR < 60 and 0 if not. Results: 364 hypertensive patients were enrolled, with an estimated incidence of renal failure of 41.8%. The mean age was 57.90 years in the general population, and 59.21 years for patients with renal failure. Females predominated, with a sex ratio of 0.78. Renal failure predominated in subjects aged 70 and over in 28% (n = 42). Hypertension was associated with the diagnosis of dilated cardiomyopathy (DCM) in 87 cases (24%) and hypertrophic cardiomyopathy (HCM) in 6 cases (1.6%). There was a statistically significant difference between the proportion of renal failure patients and non-renal failure patients as a function of age, duration of hypertension, follow-up of hypertension, grade of hypertension on admission, the presence of lower limb edema, hemoglobin level and plasma urea value. Factors associated with the onset of renal failure in hypertension were: advanced age (over 65) (OR = 2.28 95% CI [1.28 - 4.03]); unmonitored AH (OR = 2.82 95% CI [1.66 - 4.77]); grade III AH (OR = 2.05 95% CI [1.17 - 3.57]) and hyper-uremia (OR = 13.34 95% CI [7.37 - 24.14]). Conclusion: IR during hypertension is very common in Togo. The predictive factors found corroborate the data in the literature....
Introduction: Vascular access is the key to the successful management of chronic hemodialysis (HD) patients. Though native arteriovenous fistula (AVF) is considered the access of choice, many patients in our country initiate hemodialysis through the central venous catheter (CVC). Hence, successful HD depends on the creation and maintenance of adequate vascular access. Methods: A single-center, cross-sectional study of ESRD patients on maintenance hemodialysis enrolled in Perpetual Succour Hospital Hemodialysis Unit from April 1, 2021, to November 30, 2023, was employed so that vascular access outcomes of patients on maintenance hemodialysis were determined. Results. There were 260 hemodialysis patients included, with successful vascular access outcomes (73.13%) and were younger (57.2 ± 14.1). Those who had failed vascular access were females (54.2%), unemployed (61.4%) and had diabetes mellitus (50.6%) as the primary etiology of their ESRD. Those with failed vascular access were hypertensive (86.7%), with a history of CAD and MI (57.8%) and had diabetes mellitus (56.6%). The proportion of those with failed and successful vascular access significantly differs among hypertensives (p = 0.012), diabetics (p = 0.039), with chronic glomerulonephritis (p = 0.011), and those with malignancy (p = 0.003). Conclusion: In precis, the type of access, interventions carried out, and vascular access site significantly vary between HD patients with unsuccessful vascular access results and those who were successful. Patients with unsuccessful results despite treatment were those who switched to CVC, while most of those with successful vascular outcomes did not change. Reasons for changing vascular access were due to an absence of bruit and the main reason for those with failed access. Successful vascular access outcomes are significant in younger patients, and failed vascular access is mostly observed in unemployed females with diabetes mellitus....
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