Journal de néphrologie et thérapeutique

Renal transplantation (RT) is considered to be the best substitute treatment for end-stage renal failure. Urologic complications occur in 4% to 8%. A delay in detection and treatment of any of these complications may lead to loss of renal graft function, morbidity of patients. One of the most frequent complication is Vesico Ureteral Reflux. We report a case of a young transplant patient, presented with a singular complication of RT: grade III vesicoureteral reflux associated to an acquired postoperative paraureteral diverticulum, discussing the clinical and therapeutic aspects of this complication.

Introduction: End-stage renal failure has a significant impact on patients' daily lives, which can be measured by quality of life questionnaires. The objective of this study was to assess the health condition related to quality of life in hemodialysed patients in three semi-urban hospitals of Senegal and to determine the factors associated with it. Patients and methods: During an observational, transversal, descriptive and analytical study conducted for 2 months, between March 1st and April 30th, 2016, the patients' records, in 3 cities, maintained under regular hemodialysis for at least 3 months and at least 18 years old, have been analysed. The health-related quality of life assessment was executed by an interview with patients using the French version of the KDQOL SF (Kidney Disease Quality of Life Short Form) 1.3 questionnaire. Association levels between health domain values and sociodemographic, clinical and biological criteria were investigated using non-parametric Wilcoxon or Kruskal-Wallis tests where 2 or more groups are compared. Results: We included 79 out of 94 chronic hemodialysed patients during the study period. Sixty-four patients (64) effectively participated in the study. The average age was 43.3 ± 14.9 years. The KDQOL SF 36 questionnaire was completed by 64 patients. Among them eight patients did not answer the question which assesses the quality of sexual activity. In Saint Louis, the field that had the lowest score was "General Health" (54.9), and the one with the highest score was "Limitations due to mental state" with 92.8. In the Tambacounda’s unit, the lowest score was in the "Limitations due to physical condition" side (41.0), and the highest score was in the "Life and relationships with others" field at 68.0. According to the KDQOL, the "Professional Status" dimension had the lowest score and the "Encouragements received from the dialysis team" the highest score in Kaolack and Saint-Louis whereas in Tambacounda the "Professional Status" dimension had the lowest score (16.0) and that “Quality of the entourage” the highest score (87.7). Women were significantly better (93.8) than men (83.3) compared to the "Dialysis Staff Incentives" category (p=0.02). Married patients scored significantly lower, compared to unmarried patients, in the "Sexual Function" field (55.8 versus 96.1, p=0.006) and "Patient’s Satisfaction" (74.8 vs. 87.2; p=0, 01). Conclusion: Studies of the hemodialysed patients’ quality of life in semi-urban settings are rare in sub-Saharan Africa. This allows us to note a diversity of quality of life according to geographical areas.

Background: Unfractionated heparin (UFH) administered during hemodialysis (HD) has cumulative adverse effects; hence the importance of using the lowest possible dose and avoid overdosing. Methods: We analyzed 30 patients with chronic hemodiafiltración (HDF) treatment divided in 3 groups: pos filter HDF with heparin standard impregnation dose (27 ± 6.5 IU/kg), HDF pos filter with impregnation low dose (15 ± 4.2 IU/ kg); in both groups, heparin impregnation and maintenance were given, and a third group HDF pre-dilution only with heparin impregnation dose (27 ± 12.8 IU/kg). We measured partial thromboplastin time (aPTT) and serum heparin levels at 30 and 190 min, in the three groups. Results: HDF pre-dilution group received a significantly lower total dose than the other 2 groups; 1750 vs. 2650/3444 UI/Kg (p<0.001), maintaining 30 min aPTT target (55.6 ± 43.4) as aPTT 190 min (44.4 ± 30.3), as well as effectiveness of the treatment (substitution volume of 51.4 ± 11.8 L, Ktv 1.38 ± 0.3). The other two groups reached aPTT 30 min target, but decreased towards the end of HDF sessions (aPTT 190 min). HDF pre-dilution did not increase clot formation (p<0.678). There were no major coagulation or bleeding events in any of the HDF sessions. Conclusion: Pre dilution HDF with only impregnation heparin is a safe and effective method; after the amplification and reproduction of our results, it could represent an alternative treatment that minimizes UFH doses in order to reduce the associated adverse events.

Oligomeganephronia is a rare renal anomaly that leads to renal insufficiency in childhood or adolescence. It is morphologically characterized by a decreased number of nephrons with a compensatory hypertrophy of the remaining glomeruli and tubules. The disease belongs to the spectrum of kidney hypoplasia. Oligomeganephronia possesses a rather specific post-contrast computed-tomographic appearance.