Insuffisance et agression rénales aiguës périopératoires

Perioperative period is very likely to lead to acute renal failure because of anesthesia (general or perimedullary) and/or surgery which can cause acute kidney injury. Characterization of acute renal failure is based on serum creatinine level which is imprecise during and following surgery. Studies are based on various definitions of acute renal failure with different thresholds which skewed their comparisons. The RIFLE classification (risk, injury, failure, loss, end stage kidney disease) allows clinicians to distinguish in a similar manner between different stages of acute kidney injury rather than using a unique definition of acute renal failure. Acute renal failure during the perioperative period can mainly be explained by iatrogenic, hemodynamic or surgical causes and can result in an increased morbi-mortality. Prevention of this complication requires hemodynamic optimization (venous return, cardiac output, vascular resistance), discontinuation of nephrotoxic drugs but also knowledge of the different steps of the surgery to avoid further degradation of renal perfusion. Diuretics do not prevent acute renal failure and may even push it forward especially during the perioperative period when venous retourn is already reduced. Edema or weight gain following surgery are not correlated with the vascular compartment volume, much less with renal perfusion. Treatment of perioperative acute renal failure is similar to other acute renal failure. Renal replacement therapy must be mastered to prevent any additional risk of hemodynamic instability or hydro-electrolytic imbalance.     

Données épidémiologiques des biopsies rénales à l’île de la Réunion entre 2015 et 2017

IntroductionReunion Island's population is characterized by a multiethnic origin, which makes it impossible to transpose epidemiological data of Metropolitan France. Only REIN Registry provides a macroscopic view of kidney disease, limited to the causes of end stage renal disease.MethodsThis is a regional retrospective study whose main objective is to describe renal pathologies in Reunion Island's adults over a period of 3 years. Kidney transplants are excluded.ResultsBetween 2015 and 2017, 338 native adult kidney biopsies performed on the island are collected. The annual biopsy rate is 132/million/year with preponderance in the northern part of the island due to a higher density of nephrologists. Nephrotic syndrome is the first indication with 30% of cases. The four main results are represented by IgA nephropathy (16%), diabetic nephropathy (12.4%), lupus nephropathy (11.2%) and isolated vascular nephropathy (11%). Incidence of glomerulopathies is similar to the worldwide incidence, nevertheless a preponderant place of diabetic nephropathy is found. On the biopsies performed, incidence of complications is evaluated at 7.5%, with no difference between the detection technique used.ConclusionThis is the first study illustrating main renal pathologies in Reunion Island. Diabetes’ frequency in general population is a major confounding factor in diagnosis and management of kidney diseases on the island.     

Épidémiologie de l’insuffisance rénale aiguë

The acute renal failure is common in the hospitalized patients with the incidence is increasing. This results from the aging of the population and the widespread use of nephrotoxic therapies or diagnostic techniques. The acute renal failure is associated with an increased length of stay in hospital and the short and long-term mortality. The most common histological injury is the acute tubular necrosis. Although the most of acute renal failure is recovering, recent works have shown that there is a strong association between an acute renal failure and the increased risk of developing a chronic kidney disease.     

Lésions anales précancéreuses liées aux papillomavirus humains. Histoire naturelle, épidémiologie et facteurs de risque

Résumé  L’incidence du cancer de l’anus a significativement augmenté depuis le début de l’épidémie d’infection à VIH. L’infection à papillomavirus oncogènes est associée au cancer de l’anus par le biais de lésions précancéreuses. L’histoire naturelle des lésions dysplasiques anales reste mal connue.      

Incontinence fécale : données épidémiologiques et enjeux de santé publique

Fecal incontinence, which can be defined as an involuntary loss of stool, is thought to affect 8% of general population but this estimate is expected to increase with demographic ageing. All epidemiological studies about this disease are facing issues of definition and underreporting, in addition to bias usually encountered. Thus, assessment of sex ratio remains debated so as part of obstetrical events. Impact of bowel disorders, although regarded by experienced practitioners since a long time, has only recently emerged in the literature. At last, medico-economic effects are huge and to date, there is no proven track to reduce its impact.     

Les traumatismes de l’appareil génito-urinaire: Aspects épidémiologiques et lésionnels

Objectives

To analyze the frequency and the etiology of trauma to the genito-urinary tract as well as the types of lesions encountered.

Patients and Methods

This is a retrospective study carried out on 38 patients with genito-urinary trauma seen at Cocody University Hospital, Abidjan, Ivory Coast, between April 2000 and December 2006. The parameters studied were: age, sex, profession, etiology of the trauma, the type of lesions observed and their surgical management.

Results

Out of 16,425 trauma patients, 38 (0.2%) had genito-urinary lesions. Thirty-seven of them were males and one female with a mean age of 26.9 (range 5 to 63) years. The majority of the patients were victims of car accidents (42.1%, 16 cases), while 29% (11 cases) had a work accident, and 23.7% (9 cases) were victims of civil violence (physical assaults). In 81.6% of the cases, the urethra and the bladder were affected, while renal lesions and trauma to the external genital organs were found in 7.9% and 10.5% of the cases, respectively. Twenty-five patients (65.8%) had associated pelvic fracture. The trauma was direct in all patients with blunt trauma in 29 (76.3%) and penetrating trauma in 9 (23.7%). Surgical management consisted of end-to-end urethrorrhapy in the majority of patients (52.6%).

Conclusion

Genito-urinary trauma is rare and is more likely to affect young men. It is primarily caused by car and work accidents. Such trauma is usually associated with serious lesions.     

Histoire de l’insuffisance rénale aiguë et des débuts de l’hémodialyse en France

From the end of the 19th century to the 1950s, from mechanisms of disease and pathology to the first success of hemodialysis, the author depicts the history of acute kidney injury. These remarkable improvements of modern medicine led concurrently to the spread of hemodialysis for the replacement of end-stage renal disease.     

Diagnostic clinique et biologique de l'insuffisance rénale aiguë

Acute renal failure (ARF) is defined in general terms as an abrupt decrease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt fluid and electrolyte homeostasis. There is no consensus regarding a quantifiable definition of ARF. Prompt evaluation of ARF is vital because ARF can be the end result of diverse processes which can often be reversed or attenuated through therapy directed at the underlying condition. Evaluation begins with careful review of the patient's history, previous medical records, physical examination, urinanalysis, and available laboratory data. Routine urine chemical indices, calculation of the fractional excretion of sodium, and examination of the urine sediment are valuable in characterizing the cause of ARF. When this evaluation fails to yield a diagnosis, further testing may be required to evaluate intravascular volume status or diagnose a systemic disorder or glomerular cause of ARF. Response to therapeutic trials may provide a diagnosis. When a diagnosis cannot be made with reasonable certainty through this evaluation renal biopsy should be considered.     

Composition chimique des calculs urinaires et caractéristiques épidémiologiques associées en République Démocratique du Congo

To compare the chemical composition of the upper and lower urinary tract stones in Congolese patients, and to identify factors associated with the different types of stones. Stones from 119 patients originating from the upper tract and 75 from the lower tract were analyzed by infrared spectrophotometry. Among 119 patients with upper tract stones, age ranged from 10 to 81 years with a mean (SD) of 45.8 (13.6) years; males were the majority (55.5%). The main types of stones identified were whewellite (79%). For the 75 patients with lower apparatus stones, age ranged from 4 to 87 years with a mean (SD) of 51.6 (21.6) years; the majority were males (89.3%). The main types of stones were whewellite (44%) and anhydrous uric acid (22.7%). Overall, the factors associated with calcium oxalate included: site [4.95 (95% CI 2.35-10.44)] and diameter [3.03 (95% CI 1.45–6.25)]; patient's place of residence [0.05 (95% CI 0.01–0.29)] was associated with calcium phosphate. Infection stones were associated with; site [0.19 (95% CI 0.06–0.63)] and diameter [0.10 (95% CI 0.03–0.38)]. Finally, age 0.26 (95% CI 0.09–0.71) and stone site [0.23 (95% CI 0.07–0.68)] were associated with uric stones. The epidemiological and chemical profile of upper and lower tract stones were different. Several factors were associated with the chemical and crystalline composition of stones in the Democratic Republic of Congo.     

Hypercalcémie sévère et insuffisance rénale aiguë induites par étanercept

Drug-induced sarcoidosis-like disease is a rare, but not exceptional, side effect of anti-tumor necrosis factor (anti-TNF) agents. The organs most commonly involved are lungs, skin and lymph nodes. Kidney involvement is exceptional. Histology usually reveals non-caseating granulomas. Some of the biological features usually described in sarcoidosis are very infrequent in drug-induced granulomatosis. We report a case of sarcoid-like granulomatosis manifesting as life-threatening hypercalcemia and acute kidney injury in a woman treated with etanercept for a rheumatoid arthritis. Seven days after admission, she developed hypoxemic interstitial pneumonia with negative mycobacterial and fungal analysis. This picture suggested sarcoid-like disease induced by tumor necrosis factor blockers and prompted etanercept cessation. Kidney biopsy performed 30 days after admission revealed significant acute interstitial nephritis and intratubular calcium crystals. Staining for acid-fast bacilli and fungi was negative. Clinical picture improved gradually after etanercept withdrawal and cortisone treatment. Three weeks after admission, serum creatinine and calcium levels were normal. Clinical presentation of sarcoidosis-like disease induced by anti-tumor necrosis factor agents may be extremely variable. Our observation shows that severe, life-threatening hypercalcemia may occur. Renal involvement is very unusual. This case highlights this diagnostic difficulty and the importance of a close clinical monitoring in patients treated with these drugs. Cessation of the anti-tumor necrosis factor agent leads to resolution of this condition in most cases.