Journal de néphrologie et thérapeutique

Introduction: Kidney transplantation from living donors is increasing, and living donor selection criteria must be strict to ensure the safety of donors.

Materials and Methods: It is a single center retrospective study over a period of 7 years.

Results: There are 43 challenged donors. The average age is 43.9, of whom 58.3% are women, the applicants for the donation were essentially from 44.4% ascendants, and the causes of donor exclusion were: the presence of donorspecific anti-HLA antibodies, positive cross-match, age limit, diabetes, arterial hypertension, obesity, disturbed renal morphological abnormalities and vascular abnormalities

Conclusions: The selection criteria for living relatives have been expanded to increase the chances of receiving a kidney; however, some contraindications remain incontestable.

Introduction: In Senegal the drug prescription in chronic renal failure patients (CRF) is not well appreciated. The objectives of this study were to analyze drug prescription in patients with non-dialysis CRF, the factors’ progression for chronic renal disease (CKD) and occurrence of death related to drug prescription.

Patients and Methods: It was a retrospective, descriptive and analytical study carried out in the nephrology department of the LEDANTEC hospital in Dakar from January 1st, 2015 to December 31st, 2015. Were included any patient received in consultation or hospitalization with a CKD from Stage 3 and not dialyzed.

Results: The hospital prevalence was 6.06%. The average age was 56.19 ± 15.17 years. The high blood pressure (HBP) was found in 138 patients (81.66%) and 65 patients (47.10%) did not have a precise treatment. Fortyseven patients (28%) were diabetic and 9 badly followed-up. General signs such as paleness of mucosa (57.14%) and lower limbs edema (52%) were in the foreground while digestive (7.69%) and neurological (7.10%) signs were poorly represented. Therapeutically, a total of 65 drugs were prescribed and amlodipine was the most prescribed at 16.31%. Forty-nine patients (28.99%) had at least one drug contraindicated. The Acetylsalicylic acid was the most prescribed contraindicated drug 31 times or 52.54%. One hundred and three patients, or 60.95%, had at least one drug poorly adapted to renal function, and antihypertensives took over 90.91% of these inappropriate prescriptions. No maladaptation was related to the chronic renal disease development, but the contraindicated drugs had an influence on the death of the patients with a p at 0.015.

Conclusion: Our study shows that drugs contraindicated and poorly adapted to renal function are recurrently prescribed in non-dialyzed CRF. A use of the Prescription Guides and Kidney (GPR) recommendations before any prescription in the renal failure could improve the treatment in our structures.

Pseudohypoaldosteronism (PHA) types I and II share hyperkalemia as a predominant finding. PHA is a heterogeneous syndrome characterized by a lack of response of the organs to the mineralocorticoid, and therefore there is loss of salts. Heredity can be autosomal dominant or recessive. It is very rare for other mutations to occur.

Autosomal dominant PHA-I is characterized by mutations in the mineralocorticoid receptor, while Autosomal recessive PHA-I results from mutations in the epithelial sodium channel (ENaC). Clinical expression of renal PHA-I is variable: patients present with salt loss in the neonatal period, failure to thrive, vomiting, and dehydration. Symptoms of renal PHA-I often improve in early childhood and older children.

PHA-II is the result of mutations in a family of serine-threonine kinases called with- no-lysine kinases (WNK) 1 and WNK4. The predominant role of WNK1 is the regulation of cation-Cl− cotransporters (CCCs) such as the sodium chloride cotransporter (NCC), basolateral Na-K-Cl symporter (NKCC1), and potassium chloride cotransporter (KCC1) located within the kidney. WNK4, its primary role in renal physiology, is as a molecular switch between the angiotensin II–aldosterone mediated volume retention and the aldosterone mediated potassium wasting. It also regulates the (NCC) and regulates the function of renal outer medullary potassium (ROMK) channels and ENaCs. Aldosterone inactivates WNK1 and WNK4 activity.

A typical picture of congenital adrenal hyperplasia (CAH) is hyponatremia with hyperkalemia; However, in the presence of pyelonephritis, the same biochemical manifestation can occur with transient PHA-1 also known as type 4 renal tubular acidosis. We report two cases that present hyponatremia accompanied by urinary tract infection, leading to the diagnosis of transient pseudohypoaldosteronism.

The two cases support the idea that the renal tubular resistance to aldosterone is due to urinary tract infection. The two cases are presenting hyperkalemia with hyponatremia, and in whom a diagnosis of congenital adrenal hyperplasia was excluded. It is essential to know that serum aldosterone, urine sodium, and urine cultures may be obtained immediately.

Objective: Protein-energy malnutrition (PEM) is one of the most important risk factors in terms of morbidity and mortality in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). Therefore, in this population it is important to evaluate the nutritional status and body composition correctly. Our aim was to compare epicardial adipose tissue thickness (EAT) in HD patients with and without malnutrition.

Methods: Fifty-six patients were included in the study who were receiving HD therapy for ESRD. Mini Nutritional Assessment (MNA) was administered to determine the nutritional status of the patients. According to MNA scores; patients were divided into two groups as PEM+PEM risk group (group 1, n=25, score <24) and group with well-nourished (group 2, n=31, score ≥ 24). In addition, Tanita SC 330, a body composition analyzer, was used to evaluate the body composition of patients. Transthoracic echocardiography was performed to determine EAT.

Results: Of the 56 patients included in the study, 31 were male and 25 were female. EAT values were significantly different between the two groups (p=0.032). EAT value was higher in Group 2 than in Group 1 (p=0.032). Phosphor (P) (p=0.01) and CAXP (p=0.02) values were significantly higher in Group 2. In addition, fat mass (p=0.011), visceral fat percentage (p<0.001), muscle mass (p<0.001), metabolic age (p=0.01), lean body mass (p<0.001) and basal metabolic rate was significantly higher in Group 2. The highest positive correlation with EAT value was found with visceral fat ratio (r=0.600, p<0.001).

Conclusions: Malnutrition is a frequent problem in the HD population. We found low EAT in patients with malnutrition. As a result, we think that EAT can be used as a risk factor for KVC in patients without malnutrition.