Abstract Background: Cardiovascular risk factors (CVRF) are very frequent in patients with chronic kidney disease (CKD) and impose a new environment to which the heart must adapt. Cardiac ultrasound is a non-invasive and easy to-perform examination that allows quantitative and qualitative assessment of the anatomy and function of the heart. The objectives of this study were to describe abnormalities observed on trans-thoracic Doppler-echocar-diogra phy and to investigate the factors associated with them. Materials and Method: This was a monocentric retrospective cross-sectional study conducted in CKD patients hospitalized in a hospital center in Côte d'Ivoire from Janu ary 2017 to December 2018. Results: One hundred and four cases were collected with a mean age of 48.87 ± 14.47 years and a sex ratio of 1.7. Patients with end-stage-renal-disease (ESRD) represented 83.7% with 55.8% of cases of chronic glomerulonephritis. Cardiovascular risk factors were 100% anemia, 84.6% inflammatory profile, 77.9% hypertension, 76.9% hypocalcemia and in 67.3% oedema. Cardiac abnormalities were observed in 78.8% of patients. Left ventricular hypertrophy (LVH), accounting for 20.2% of cases, was asso ciated with male gender (OR 0.127 CI 0.025 - 0.643; p = 0.013) and hypertensive nephropathy (OR 0.189 CI 0.056 - 0.637; p = 0.007). History of hypertension (OR 0.297 CI 0.084 - 1.050; p = 0.060) and diabetes (OR 5.315 CI 1.260 -22.419; p = 0.023), hypertensive nephropathy (OR 0.174 CI 0.052 - 0.585; p =0.005) and hypocalcemia (OR 6.094 CI 1.723 - 21.559; p = 0.005) are incriminated in the development of left ventricular dilatation (LVD) which accounted for 38.5% of cases. Conclusion: Left ventricular hypertrophy and dilatation are the main echocardiographic abnormalities observed in our population .

Abstract Introduction: Inflammation has been implicated as a major reason for the higher morbidity and mortality in chronic kidney disease (CKD) compared to the diseases that commonly precedes it. The neutrophil lymphocyte ratio (NLR) has increasingly been reported to be a marker of systemic inflammation. We studied the neutrophil lymphocyte ratio and its relationship with kidney function and other markers of inflammation in health and in CKD. Methods: Two hundred and forty four participants in three cohorts: healthy, CKD stage 1 - 2 and, stage 3 - 4, were studied. Data of clinical, NLR, uric acid, urine albumin creatinine ratio (UACR), electrolytes were documented and independent associates of NLR were determined. Results: The NLR was higher in the CKD cohorts, P < 0.001 and females, P = 0.01. The mean NLR of all participants, the healthy and, CKD cohorts were 2.8 ± 0.7, 1.5 ± 0.6 and 3.9 ± 1.4, P < 0.001. The mean NLR of all participants ≥ 65 years, all males ≥65 years and, all females ≥ 65 years were 4.0 ± 1.6, 3.7 ± 1.0 and 4.2 ± 1.2, P = 0.01. The NLR was positively related to the age (P < 0.001), systolic blood pressure (P = 0.012), uric acid (P = 0.018), UACR (P = 0.006) and platelet lymphocyte ratio, P = 0.04. The NLR was negatively related to the hematocrit (P < 0.001), albumin (P < 0.001) and glomerular filtration rate (P < 0.001). Multivariate analysis after ruling out cofounders, showed age (aOR5.8, CI 4.26 - 10.22), systolic hypertension (aOR1.5, CI-1.21 - 2.07), hyperuricemia (aOR-1.5, CI-0.94 - 2.09), elevated urine ACR (aOR-1.7, CI-1.25 - 2.47) and CKD (aOR-7.2, CI-1.45 - 8.94) as independent predictors of NLR. Conclusion: The NLR as an inflammatory marker is elevated in chronic kidney dis ease, and increases with disease severity hence it can be a useful tool in determining the presence and severity of inflammation in CKD.

Abstract Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to as sess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through med ical record revision of 101 patients with type 2 diabetes undergoing percuta neous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p < 0.018), a short duration of diabetes (p < 0.000), lower proteinuria (p < 0.030), and had high er hemoglobin levels (p < 0.006) compared to non-NDRD patients. In multi variate logistic regression analysis, the short course of diabetes (OR 0.986; 95% CI = 0.978 - 0.993; p = 0.000) and older age (OR 1.080; 95% CI = 1.028 -1.134; p = 0.002) were significant risk factors for NDRD occurrence. In ROC analysis for NDRD, the duration of diabetes ≤ 78 months (cut-off value (0.725,0.313)) illustrated the highest AUC. Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized pros pective investigations focused on identifying possible risk markers of NDRD are still in priority.

Abstract Background: To evaluate bone-mineral-density-BMD determined by dualenergy X-ray absorptiometry-DEXA and bone turnover markers in chronic-kidney-disease-CKD patients. Method: An observational-clinical study of all patients who were scanned by DEXA-scan in 2018. All patients with lowbone-density or osteoporosis-based on World-Health-Organization-WHO definition were included. Results: 505 patients with abnormal-BMD, 87.3% were in early-stage CKD-stage I - II, 8.5% were in CKD-stage III - V and 4.2% did not have renal tests. 95 (18.8%) were male with a mean age of 57.0 years and 410 (81.2%) were females with a mean age of 55.8 years. Patients of ≥65 years had lower T-score than those who were younger than 65 years-old. Among CKD patients, those with late-CKD (stage III - V) had less BMD-measurements and lower T-score than those with early-CKD (stage I - II). A significant positive correlation exists between parathyroid hormone-PTH-level and the lower T-score. Female had a worse T-score at the lumbar-region whereas male had a worse T-score at the femoral-region. There was no significant difference between males and females for the T-score at hip-region. Conclusion: We observed a distribution of abnormal BMD among different age, sex and CKD groups. Measurements of BMD by DEXA might be a useful test to diagnose osteoporosis in CKD patients. Femoral and total hip areas were more affected, however DEXA might not be able to detect osteoporosis in the lumbar area of CKD patients. T-scores are lower in patients with more severe CKD and lower in elderly patients. PTH level is associated proportionally to the degree of bone loss. Early intervention and proper management must be implemented early among CKD patients with multidisciplinary team approach strategy. More studies are needed to determine if DEXA techniques are enough to distinguish the quantity of bone loss between different stages of CKD.

Abstract Background: Late referral of Chronic Kidney Disease (CKD) patients requiring emergency hemodialysis (HD) for survival poses a serious threat to global health particularly in sub-Saharan Africa (SSA). Objective: Describe the epidemiological and clinical profiles of CKD patients starting HD in emergency.Methodology: This was a retrospective cross-sectional study. Files of patient files of CKD patients who underwent dialysis from January 1st, 2016 to December 31st, 2020 were reviewed at the HD centres of the two main hospitals of the Cameroon city capital, Yaoundé. We included all emergency HD for End Stage Renal Disease (ESRD). Socio-demographic and clinical data including past medical history, signs and symptoms at presentation and indications for emergency HD were recorded. Emergency HD was defined as a dialysis session performed in ESRD with a temporary vascular access. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 for Windows. Results: Out of 700 recorded CKD patients who started HD, 570 underwent an emergency HD, thus a prevalence of 81.43%. We included 311 patients, 63.7% were males. The mean age was 47.05 ± 15.60 years ranging from 8 to 83 years with a modal age group of 40 - 59 years. The most prevalent co morbidities were hypertension (66.2%), diabetes mellitus (28.6%) and HIV infection (10%). The commonest presenting symptoms were asthenia (68.2%), lower limbs swelling (52.1%) and anorexia (41.8%) and the main clinical signs were high blood pressure (74.92%), and pallor (60.5%) and altered general state (55%). The indications for emergency HD were dominated by uremic encephalopathy (33.4%) and pulmonary oedema (25.7%).Conclusion: More than eight out of ten CKD patients start emergency HD. Patients are mostly middle-aged adults with a male predominance. Hypertension and diabetes mellitus remain the most common co morbidities and uremic encephalopathy is by far the first indication for emergency HD.

Abstract Idiopathic granulomatous ureteritis (IGU) is a rare autoimmune disorder. Multiple case reports led to defining its clinicopathological inclusion criteria in 1997. Surgical resection and primary reanastomosis, of such pseudotumor, were considered its definitive management and a 4-months corticosteroidtherapy was used once for persistent ureteric lesion despite of 3-months stenting. Long-term follow-up of such disease is limited and management of its extensive and recurrent disease is lacking. In our case report, a 47-year man had history of a biopsy-proven IGU 4 years ago that was treated with resection and ureteral reimplantation in a cystoplastic (augmented) bladder. Moreover, he had received Corticosteroids and Azathioprine for a total of 2 years to avoid recurrence. Two years later, he presented with recurrent abdominal pains, urinary tract infections and ultimately; bladder neck disease. Cystoscopic examination revealed extensive bladder masses and severe left ureteric stricture. Biopsy of the bladder lesions confirmed the idiopathic granulomatous disease. He improved, with immunosuppressive therapy that included 3 months of Corticosteroids and Mycophenolate mofetil followed by maintenance therapy with Mycophenolate mofetil. Previous animal studies have shown local hyperimmune response with malformation of the transitional epithelium in a genetically predisposed mice indicating genetic predisposition with immune-mediated expression. Hence, in our patient, we proposed long-term immunosuppressive therapy and follow-up. In conclusion; our case report confirms the autoimmune etiology of such disorder and provides new line of management of its extensive and recurrent variant.

Abstract Introduction: Pulmonary hypertension (PH) is defined as high blood pressure in the lungs. It is recently described as a vascular disease entity in chronic kidney disease, particularly for chronic hemodialysis patients. The aims of this study were to determine the prevalence of PH, to describe clinico-biological and morphological characteristics and to identify risk factors associated with PH in hemodialysis patients. Patients and methods: This is a cross-sectional, descriptive, and analytical study during a period of 8 months from January 1, 2019, to August 31, 2019, in the hemodialysis center of nephrology department of Aristide Le Dantec Hospital. All chronic hemodialysis patients for more than 3 months and with PH confirmed by cardiac doppler ultrasound were included. Results: During the study period, 25/94 patients on chronic hemodialysis, presented with pulmonary hypertension (26.6%). The mean age was 49.3 ± 12.9 years. The sex ratio (M/F) was 0.92. Exertional dyspnea was found in 18 patients (72%). Cardiac auscultation revealed an arrhythmia in 3 patients (12%), augmented second heart sound in 12 patients (48%). On transthoracic doppler ultrasound, pulmonary systolic arterial pressure was on average 51.4 ± 13.2 mmHg. PH was moderate in 13 patients (52%), mild in 9 patients (36%) and severe in 3 patients (12%). The left ventricular ejection fraction was altered in 9 patients (36%). Three patients (12%) had valve calcifications. They were mainly located at aortic valve (8%) and mitral valve (4%). The major risk factors associated to PH in our patients are pathological fractures (p = 0.023), aortic calcifications (p = 0.023), ischemic heart disease (p = 0.023). The duration of hemodialysis represents another favoring factor (p = 0.042). Also implicated are arrhythmias (p = 0.004), high cardiac index (p = 0.043), ventricular dilatation (p = 0.034) and left atrial dilation (p =0.015), as well as dilation of the inferior vena cava (p = 0.048).

Abstract We present the 3rd known case of a Serratia rubidaea urinary tract infection in a 49-year-old male with past medical history of bilateral lower extremity paraplegia who presented to the emergency room with fever, lethargy, and red tinted urine. The Serratia genus, of the family Enterobacteracia, in particular the species Serratia marcescens, are important causes of infection in humans, animals, and insects, however, until the mid-1950s, this was not the case, and the organism was considered non-pathogenic and frequently used in medical experiments. Serratia are facultatively anaerobic, gram-negative rods, the majority with peritrichous flagella primarily inhabiting soil, water, and plant surfaces. Serratia marcescens is now a known pathogen, however, less frequently isolated species, including Serratia rubidaea, are worthy of discussion, especially due to its characteristic red color and rarity. We aim to increase the awareness Serratia rubidaea including its presentation, inherent antimicrobial resistance, and treatment options.

Abstract Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characteristics, and risk factors of mortality in hemodialysis patients with infective endocarditis. Methods: A retrospective study from November 2019 to November 2021 including hemodialysis patients with IE hospitalized in Ibn Sina hospital center in Rabat. Results: Eighteen hemodialysis patients were included. Mean age was 49.5 ± 18 years, sex ratio was 0.8. Catheters were the access sites most commonly used (72.3%). Median duration of hemodialysis was 12 [6; 24] months. Staphylococcus species is major causative bacteria in 60%. The mitral valve was the most commonly affected (44%). Frequent complications including valve insufficiency (50%), septic embolism (66.7%). Four patients underwent surgery and eight died during hospitalization (44.5%). Mitral localization of vegetation was the only factor significantly associated with mortality in our study (P < 0.05). Conclusion: The catheter was the most commonly used access site compared to the arteriovenous fistula. This confirms that it’s the vascular access of choice for his low rate of infectious complication compared to the catheter.

Abstract Background: Henoch-Schönlein purpura (HSP) is an acute systemic disorder characterized by IgA associated vasculitis. The available data indicate an inherited predisposition to disease with triggering autoimmune phenomena. Hence, we evaluated prospectively the role of a new autoimmune regimen in treatment of its severe nephrotic/nephritic flares associated with non-crescentic nephritis in adult patients. Patients and methods: The regimen consisted of an initial induction phase of 3-month Prednisone and Mycophenolate followed by a maintenance phase of Mycophenolate alone for 2 years. Results: They were satisfactory with complete remission in 5 of 7 patients and partial in 2. Creatinine clearance was normalized in patients with complete remission and remained stable in the partially-responsive ones. Conclusion: Our study has shown the short- and long-term safety and efficacy of such autoimmune regimen directed towards the autoimmune triggering factors in severe forms of non-crescentic HSP.

Abstract Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination.Results: One hundred and twenty-three patients on regular hemodialysis were interviewed; their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.

Abstract Background: Worldwide, diabetic nephropathy-DN is the leading cause of end-stage kidney disease-ESKD, DN is a common cause of renal failure with a reported frequency of 10% - 15% in type-2-diabetes-mellitus-T2DM patients, however there is a great discrepancy between countries. The aim of the present study is to evaluate the findings of kidney biopsies performed on diabetic patients. Materials and Methods: We studied native kidney histopathological findings in the period from January 2016 till end of December 2018 done for patients with T2DM with chronic kidney diseases-CKD. Results: A total of 82 DM-patients, 50 males (61%) and 32 females (39%) with age mean (95% CI) of 50.8 (47.1 - 55.2) years for all patients, ranged between 15 to 65 years. Histological findings showed that 57.3% of patients had DN. While focal-segmental-glomerulosclerosis-FSGS was present in 20.7%—primary in 8.6% and secondary in 12.1%. IgA represented 4.9%, while Lupus nephritis, Membranous and drug induced interstitial nephritis were each present in 3.7%. MCD was present in 2.4%. Lastly diffuse proliferative GN, ANCA associated glomerulonephritis, and hypertensive nephrosclerosis accounted for 1.2%. Conclusion: The prevalence of NDKD is remarkably frequent in DM patients who underwent kidney biopsy and FSGS was the most frequent diagnosis. To get a proper histopathological diagnosis, an adequate tissue biopsy is needed with an adequate number of glomeruli. There is a great need for more consideration to biopsy diabetic patients, as the finding of NDKD requires a different therapeutic approach. This, hopefully, will help to manage these patients better and therefore, ameliorate the progression to ESKD over time and therefore delay the need for RRT.