Journal of Nephrology & Therapeutics

Introduction: Preeclampsia and its complications are a major public health problem in Africa and worldwide, because they cause very high maternal and fetal morbidity and mortality. Few studies have been conducted in Chad. The main objective of this study was to describe the role of the urine dipstick in the diagnosis of preeclampsia at the Bon Samaritain University Hospital of N'Djamena.

Patients and Method: This was a descriptive cross-sectional study with a 12 months prospective data collection from August 1st, 2017 to July 31st, 2018 conducted at the Bon Samaritain University Hospital in N'Djamena, Chad. All parturient women who developed hypertensive disorders of pregnancy that were hospitalized in the obstetrics and gynecology department were included. A free and verbal consent was obtained from the patients after they were informed about the study. The variables studied were socio-demographic, clinical, paraclinical, therapeutic and evolutionary. The data collected was analyzed by Excel 2016.

Results: Out of a total of 3067 pregnant women, 80 of those were diagnosed with preeclampsia, with a hospital prevalence of 2.6%. The average age was 24.9 years ±6.9 with a range of 15 to 43 years. The pregnant women were primiparous in 65% of the cases. It was noted that 10% of the pregnant women had a premature birth. Patients had presented with pregnancy-induced hypertension in 7.5% and preeclampsia in 6.25% of the cases. In 12.5% of the cases, the presence of chronic hypertension was noted. On admission, a systolic blood pressure of ≥ 160 and/or a diastolic blood pressure of ≥ 110 was noted in 62.5% of the cases. The urine dipstick showed proteinuria with 1 cross (7.5%), 2 crosses (38.8%), 3 crosses (48.7%) and 4 crosses (5%). A clinical evolution was favorable in 53.8% of the cases. Complications were mainly represented by eclampsia (31.2%), retroplacental hematoma (2.5%) and death (2.5%).

Conclusion: Preeclampsia is underdiagnosed in our country. A good follow-up of the pregnancy during antenatal and postnatal periods with the utilization of a urine dipstick test during routine investigations will solve this problem and avoid complications.

Background: According to randomized controlled studies, protein-restricted diets supplemented with ketoanalogues effectively prolong the time until dialysis while maintaining nutritional status in patients with chronic kidney disease. The aim of the present study was to investigate whether such effects are also observed in real-world practice.

Methods: Multicentre, prospective, observational study over 12 months in 164 predialytic patients on a protein-restricted diet supplemented with ketoanalogues, prescribed according to recent standard of care. Main outcome variables were patients’ compliance, yearly decline in estimated glomerular filtration rate (eGFR), initiation of renal replacement therapy or 50% reduction in initial eGFR (composite endpoint), and time to dialysis start.

Results: At baseline, patients were educated about ketoanalogue intake and for the planned diet. Half of them (50.1%) required at least one further counselling over the study period. Mean daily protein intake was 0.6±0.2 g/kg body weight according to self-reported diaries. Daily ketoanalogue dose was 7.4±3.3 tablets at baseline. Adherence to ketoanalogue prescription was good with a compliance rate of ≥99% in 75% of patients. Mean eGFR remained stable throughout the observation period with a marginal decrease of 1.028±6.101 mL/min/1.73m². Notably, only 26 of 155 patients (16.8%) reached the composite endpoint. Mean time to dialysis start was 213±106 days. In general, ketoanalogues were safe and well tolerated.

Conclusion: Protein restriction with ketoanalogue supplementation was successfully managed in an everyday outpatient setting. Patient education and support were sufficient to ensure treatment compliance. These findings strengthen the evidence of protein-restricted diet supplemented with ketoanalogues to preserve renal function and nutritional status in predialysis patients over 12 months.

It is important to consider how patients are feeling when dealing with chronic conditions and the side effects that come with it, such as despair, worry, and pain, whether it is acute or chronic. Although chronic illnesses may not entirely go away, what is remembered is how the patient handles the condition, its side effects, and the treatments used to diminish or alleviate it. In addition to medicine or other forms of support, this typically entails providing the patient with additional coping techniques for anxiety, depression, and pain management.

Male kidney transplant recipients and matched control men without kidney transplants showed similar rates of prostate cancer diagnosis, clinical prostate cancer features, and prostate cancer-specific death. In comparison to control males, the likelihood of developing an advanced or poorly differentiated prostate cancer did not rise with time in transplant recipients. More than half of transplant recipients had been on immunosuppression for more than 9 years, and almost half had received their transplants before PSA testing was a standard part of the pre-transplantation examination. Thus, it is unlikely that immunosuppression following kidney transplantation will have a negative impact on the beginning or advancement of prostate cancer.