Analyse physico-chimique de l’eau de l’unité d’hémodialyse du chr de Saint- Louis (Sénégal)

L’insuffisance rénale chronique est un des problèmes majeurs de la santé publique dans le monde. Au Sénégal, une étude récente réalisée dans la population générale adulte avait retrouvé une prévalence de l’ordre de 6,1%. «L’eau pour dilution de concentrées d’hémodialyse» est produite en continue et utilisée en grande quantité chez l’hémodialysé chronique, donc il apparaît primordial de veiller à sa bonne qualité. Au Sénégal, aucune étude n’a été faite à ce jour pour évaluer l’efficacité du système de traitement de l’eau pour dilution des concentrés de dialyse dans les différents centres de dialyse du pays. L’objectif de ce travail est de contrôler l’efficacité du système de traitement de l’eau pour dilution de concentrées d’hémodialyse afin de s’assurer de son innocuité. Les prélèvements ont été effectués au niveau de trois points clés du circuit de traitement de l’eau pour hémodialyse. A l’entrée et à la sortie de l’osmoseur, à la sortie de la boucle de distribution. Les analyses ont été effectuées à l’aide d’électrodes spécifiques. Les valeurs de potentiels ont permis de tracer les courbes d’étalonnage. La détermination par régression des pentes et des ordonnées à l’origine de la relation de Nernst donne E(mV ) = B - A Log Cm avec des coefficients de corrélation variant entre 0,988 et 0,999 prouvant que 98% au moins des variations de tensions mesurées (E) sont attribuables à la concentration. L’analyse physico-chimique des teneurs en chlorures, nitrates et fluorures révèle des teneurs plus élevées à l’entrée de l’osmoseur qu’à la sortie. Ces basses valeurs découlent du rôle de l’osmoseur qui filtre une grande partie des électrolytes. Par contre, à la sortie de la boucle de distribution les teneurs en électrolytes des différents échantillons étaient plus importantes que celles à la sortie de l’osmoseur. Cette forte concentration en électrolytes atteste d’une pollution par la boucle de distribution de l’eau déjà filtrée par l’osmoseur. L’intérêt de cette étude réside dans le fait qu’elle met en lumière l’importance du contrôle de la qualité de l’eau pour l’hémodialyse et la nécessité d’un bon planning de maintenance préventive efficace de l’ensemble de la boucle de traitement d’eau au sein de chaque centre.© 2016 International Formulae Group. All rights reserved.Mots clés: Hémodialyse, eau, chlorures, fluorures, nitrates, électrodes spécifiquesEnglish Title: Physicochemical analysis of Saint–Louis regional hospital’s hemodialysis unit’s water (Senegal)English AbstractChronic kidney disease is a major public health problem worldwide. In Senegal, a recent study in the general adult population found a prevalence of about 6,1%. "Water for diluting concentrated hemodialysis" is produced and used continuously at high levels in hemodialysis chronic. It is therefore essential to ensure its quality. In Senegal, no study has been done to assess the effectiveness of water treatment system for dialysis concentrates dilution in different dialysis centers of the country. The objective of this work is to monitor the effectiveness of the water treatment system for hemodialysis concentrated dilution to ensure its safety. The samples were taken on key issues of hemodialysis water’s treatment circuit. Three levels of sampling were selected. At the entrance and at the outlet of the reverse osmosis unit at the outlet of the distribution loop. Analyses were performed using specific electrodes. Potential values allowed us to map the calibration curves. Determination by regression of slopes and intercepts of the Nernst relation gives with correlation coefficients ranging from 0.988 to 0.999 showing that at least 98% of the measured voltages fluctuations (E) are attributable to the concentration. Physicochemical analysis of the levels of chlorides, nitrates and fluorides reveals higher levels at the entrance of the reverse osmosis unit than at the outlet. These low values resulting of the role of reverse osmosis which filter much of the electrolytes. For against, at the outlet of the distribution loop the electrolyte content of the different samples were greater than those at the outlet of the reverse osmosis unit. This high electrolyte concentration attests to pollution of the water distribution loop already filtered by reverse osmosis. The interest of this study lies in the fact that it highlights the importance of monitoring the quality of water for hemodialysis and the need for good planning for effective preventive maintenance throughout the water treatment loop within each center.© 2016 International Formulae Group. All rights reserved.Keywords: Hemodialysis, water, nitrates, fluoride, chloride, specific electrode

Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa

Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed.L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires

Correction: Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa

The authors of the article ‘Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa’ [1] wish to acknowledge the contribution of Professor Hussein El Fishawy. Our guidelines drew on various sources, including the Egyptian Ministry of Health guidelines, portions of which were adapted and reproduced with permission from the Egyptian Ministry of Health. Two of the authors of those guidelines, Professors Elsayed and Zaki, are also coauthors of our paper. Professor El Fishawy was the third author of the Egyptian guidelines and we would like to acknowledge his contribution to our review through this source, especially with respect to the treatment algorithms for patients with kidney transplants and those with acute kidney injury. Reference1. Elsayed HM, Wadee S, Zaki MS, Were AJO, Ashuntantang GE, Bamgboye EL, et al. Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa. Afr J Nephrol. 2020; 23(1):109-126

Low Immune Response to Hepatitis B Vaccine among Children in Dakar, Senegal

HBV vaccine was introduced into the Expanded Programme on Immunization (EPI) in Senegal and Cameroon in 2005. We conducted a cross-sectional study in both countries to assess the HBV immune protection among children. All consecutive children under 4 years old, hospitalized for any reason between May 2009 and May 2010, with an immunisation card and a complete HBV vaccination, were tested for anti-HBs and anti-HBc. A total of 242 anti-HBc-negative children (128 in Cameroon and 114 in Senegal) were considered in the analysis. The prevalence of children with anti-HBs ≥10 IU/L was higher in Cameroon with 92% (95% CI: 87%–97%) compared to Senegal with 58% (95% CI: 49%–67%), (p<0.001). The response to vaccination in Senegal was lower in 2006–2007 (43%) than in 2008–2009 (65%), (p = 0.028). Our results, although not based on a representative sample of Senegalese or Cameroonian child populations, reveal a significant problem in vaccine response in Senegal. This response problem extends well beyond hepatitis B: the same children who have not developed an immune response to the HBV vaccine are also at risk for diphtheria, tetanus, pertussis (DTwP) and Haemophilus influenzae type b (Hib). Field biological monitoring should be carried out regularly in resource-poor countries to check quality of the vaccine administered

Current indication of plasma exchanges in nephrology: A systematic review

Therapeutic plasma exchange (TPE) has been firstly performed with centrifugation devices used in blood banking procedures. Nowadays, TPE is increasingly performed in intensive care units using hemodiafiltration generators that ensure better efficiency and simplicity. However, prescription for the different medical pathologies depends on weak evidence-based recommen-dations, and is often guided by the clinician′s own experience. In this review, we briefly recall the rationale of TPE prescription before discussing the evidence level of common indications of TPE in nephrology. Currently, strong evidence-based data for the benefit of TPE is clearly demonstrated in renal diseases such as hemolytic uremic syndrome, anti-glomerular basement membrane vasculitis, and recurrent glomerulonephritis after kidney transplantation and management of humoral renal allograft rejection in high-risk recipients. However, the other indications of TPE, such as renal vasculitis associated with anti-neutrophil cytoplasmic antibodies, mixed cryoglobulinemia, periarte-ritis nodosa, and acute renal failure in myeloma are still controversial. Finally, TPE have been found to be clearly inefficient in lupus nephritis, except for patients with associated thrombotic mic-roangiopathy or catastrophic antiphospholipid antibodies syndrome. More randomized clinical trials are required to precisely place TPE in the management of renal diseases. Meanwhile, the decision to use this burdensome and costly therapy should be individualized according to its proven benefits and potential complications

Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa

CITATION: Elsayed, H. M. et al. 2020. Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa. African Journal of Nephrology, 23(1):109-126, doi:10.21804/23-1-4097.The original publication is available at https://www.journals.ac.zaENGLISH ABSTRACT: Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed. L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires.https://www.journals.ac.za/index.php/ajn/article/view/4097Publisher's versio