Revista de nefrología y terapéutica

Antimicrobial resistance is one of the major global burdens and challenging the advancements in biomedical research. Urinary Tract Infection (UTI) is one of that kind, which is caused by bacteria, fungi and or virus. The treatment options also vary based on the cause, antibiotics are recommended for bacterial UTI whereas antivirals are effective against fungal/viral UTI. The recent findings uncovered the side effects of fluoroquinolones in empiric UTI treatment. Hence, re-evaluation of efficacy profiles of current empiric UTI treatment with nitrofuran derivates (NFD) is necessary.

Background: Acute kidney injury (AKI) is a common disorder with high morbi-mortality especially in developing countries. In contrast to high income regions, AKI in these areas tend to be more community-acquired and affect young people. As in most Subsahara countries, previous studies on AKI in Cameroon were carried out in urban tertiary hospitals. Data on the clinical pattern and outcomes in semi-urban is lacking and may be quite different of urban setting. Objective: To describe the clinical pattern and outcomes of AKI in Buea Regional Hospital.
Methods: We conducted an 18 months’ hospital-based observational retrospective study in the regional hospital of Buea, a semi-urban second category health facility of the South-West region of Cameroon. We excluded patients with known CKD (Chronic Kidney Disease)and incomplete data. AKI was diagnosed and classify according to the 2012 KDIGO criteria. Renal outcome was evaluated at 1 month.
Results: Of the 196 participants included, 57.7% were males and 10.7% children. The median age was 45 years. HIV infection, hypertension and diabetes were the main comorbidities. AKI was community-acquired in 95% and stage 3 was found in 59%. Sepsis (37.2%), volume depletion (25%) and nephrotoxicity from herbal remedies (15.3%) were the main etiologic factors. Renal AKI was found in 72% of patient and was mostly due to ATN (56.6%). Obstetrical AKI was mainly due to post-abortum sepsis and AKI related malaria were the main etiology of pediatric AKI. In all, 71 (36%) participants had indications for dialysis but only 52 (73%) accessed it. Lack of appropriate dialysis technique and lack of funds were the main reasons for dialysis non-access. In-hospital mortality was 37.2%. Among survivors, renal recovery was complete in 65%, partial in 21%, and no recovery in 3%. Stage 3 disease was the only predictor of poor renal recovery at one month.
Conclusion: AKI in this semi-urban hospital setting is community acquired and affected young individual with previous comorbidities such as HIV/AID, hypertension and diabetes. It is mainly caused by infections, volume depletion and herbal toxins.

Background: Protein-energy wasting (PEW) and dyslipidaemia are strongly associated with cardiovascular disease (CVD) and accelerated atherosclerosis in end-stage renal diseases patients. Our study aimed to assess the impact of malnutrition on lipid profiles and cardiovascular risk of Moroccan haemodialysis patients using lipid ratios and the atherogenic index of plasma (AIP).
Methods and Patients: This cross-sectional study included 126 Moroccan haemodialysis patients aged >18 years who had undergone dialysis for >6 months. Patients were divided into three groups: well-nourished patients (group 1), moderately malnourished patients (group 2) and severely malnourished patients (group 3). For each participant, clinical markers of malnutrition such as serum albumin and prealbumin were measured. Anthropometric measurements and a fasting lipid profile were taken and specific lipid ratios were assessed, as well as the AIP.
Results: The mean age of our participants was 44.81 ± 14.01 years old. The most common lipid alteration recorded was increased non-HDL-C (88%) followed by decreased HDL-C (70%), and hypertriglyceridaemia (30%). Malnourished patients had a higher cardiovascular risk with AIP >0.21. We observed a significant decrease in lipid parameters parallel to the increasing severity of malnutrition increased. Group 3, had highly significantly lower values for serum albumin, serum prealbumin, Body mass index (p =0.0001) and non-HDL-C (p =0.01) than group 1. Group 2 presented significantly higher values compared to group 3 (p<0.0001) for albumin, prealbumin and non- HDL-C, and very significantly values (p <0.01) for BMI, LDL-C, HDL-C, TG, TC/HDL-C, non- HDL/HDL-C and AIP. Pearson’s correlation coefficients of lipid ratios showed greater values than those of lipids alone. AIP was positively correlated with lipid ratios and nutritional markers such as serum albumin and prealbumin.
Conclusion: Our study is the first one in Morocco which confirms that Protein-energy wasting affects the serum lipoprotein profile of haemodialysis patients. Lipid ratios, especially atherogenic index of plasma, may be useful tools for diagnosing and assessing the risk of cardiovascular disease in malnourished haemodialysis patients.

Background: Non-lupus full-house nephropathy is defined as “full-house” immunofluorescence pattern in patients without systemic lupus erythematosus. We compiled our adult case series with non-lupus full-house nephropathy evaluating etiology, clinical presentation and outcomes and in addition comparing them with lupus nephritis patients from our base records.
Methods: We included patients with full-house immunofluorescence pattern in renal biopsies collected between January 2000 and January 2017, excluding lupus nephritis. Patients with Non-lupus full-house nephropathy that did not show any underlying disease (the idiopathic group) were compared with a group of lupus nephritis patients extracted from our database (n=20).
Results: Non-lupus full-house nephropathy was identified in 20 patients (14 males) with mean age, 40.05 ± 12.37 years; mean serum creatinine, 1.63 ± 1.41 mg/dl and mean proteinuria, 6.35 ± 4.48 g/day. The most common light microscopy pattern was membranoproliferative glomerulonephritis in 9 cases (45%). During follow-up 4 patients met the criteria for systemic lupus erythematosus; 5 with others systemic diseases and 11 with idiopathic form. On last follow-up visit serum creatinine was higher in idiopathic non-lupus full-house nephropathy group compared to fullhouse lupus nephritis.
Conclusion: Non-lupus full-house nephropathy is a rare condition, affecting mainly males, with the predominance of the idiopathic form and this form showing higher final creatinine levels compared to full-house lupus nephritis.