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Epidemiological Profile of Chronic Kidney Disease at the General Hospital of National Reference of N’Djamena (Chad)  [PDF]
Ibrahim Hamat, Guillaume Mahamat Abderraman, Zeinab Ma?ga Moussa Tondi, Mahamat Youssouf, Mouhammadou Moustapha Cisse, Fotclossou Tara, Elhaj Fary Ka, Abdou Niang, Boucar Diouf
Open Journal of Nephrology (OJNeph) , 2016, DOI: 10.4236/ojneph.2016.63010
Abstract: Introduction: Chronic renal failure is a disease that affects many patients worldwide and increasingly in Africa. At the end of 2003, about 1.1 million people were suffering from End-Stage Renal Disease (ESRD) and were treated with periodic dialysis [12]. In Africa, CKF represents 2% to 10% of hospital admissions and is responsible for 4% to 22% of deaths [14]. So, this study is conducted for the first time in Chad, with the aims to determine the prevalence of CKD. Methods: This was a retrospective, descriptive and analytical study over a period of 12 months from April 29, 2011 to April 28, 2012. All patients with chronic renal failure regardless of etiology and stage of chronic kidney disease were included in the study. Chronic renal failure was defined as a glomerular filtration rate below 60 ml/min/1.73m (MDRD) for more than 3 months. This study was conducted in several departments of the National General Reference Hospital (NGRH) of N’Djamena. Result: Among 2039 inpatients, 195 patients had chronic renal failure, as a frequency of 9.6%. The average age of our patients was 51 ± 16.8 years, ranging from 11 to 85 years. Male predominance was noted to be 59% of men against 41% of women. We noted that high blood pressure accounted for 66.2% (N = 129) of cases, diabetes in 48.2% (N = 94), alcoholism in 28.7% (N = 56), smoking in 14.9% (N = 29) and the association alcoholism-smoking in 19.5% (N = 38). Hypertension was the leading cause of chronic renal failure (66.2%). All patients had a serum creatinine and creatinine clearance was assessed. Among them, we noted 57 patients (29%) with end-stage renal failure. The average calcium and phosphate serum were 1.8 mmol/l and 1.6 mmol/l, respectively. We noted that 120 patients as 61.5%, currently took herbal medicine. 48 out of 57 of our patients with ESRD as 24.6% of patients in the study had received replacement therapy (hemodialysis) with 12.5% of deaths. Conclusion: Chad, who compiled the first study with 195 patients at the General Hospital of N’Djamena National Reference over a period of one year has objectified a prevalence of chronic renal failure of 9.6%.
Asymmetric and Symmetric Dimethylarginine in Adolescents with Hyperuricemia  [PDF]
Edyta Tenderenda-Banasiuk,Anna Wasilewska,Katarzyna Taranta-Janusz,Agata Korzeniecka-Kozerska
Disease Markers , 2013, DOI: 10.1155/2013/267697
Abstract: The purpose of this work was to investigate if in adolescents with hyperuricemia serum levels of asymmetric and symmetric dimethylarginine (ADMA, SDMA) are increased and if their levels correlate with serum uric acid (UA). Patients and Methods. The study group consisted of 58 hyperuricemic patients aged median 16.15 (14–17). The reference group contained 27 healthy individuals with normal serum UA level. ADMA and SDMA were measured by immunoenzymatic ELISA commercial kits and expressed in μmol/L. Serum UA was measured by the colorimetric method. Results. In hyperuricemic patients serum ADMA values did not differ between two estimated groups ( ); however, SDMA was significantly higher than in reference group ( ). Serum ADMA and SDMA correlated positively with UA ( , ) ( , ) and hs-CRP ( , ) ( , ), respectively. Conclusion. We demonstrated increased SDMA but not ADMA levels in adolescents with hyperuricemia and their correlation with serum uric acid levels. However, at the moment it is difficult to answer the question if it is just coexistence of these factors or any mechanism linking uric acid and methylated arginines really exists. 1. Introduction Uric acid (UA) has been formerly considered as a major antioxidant in human plasma with possible beneficial antiatherosclerotic effects; however, since the beginning of the Twentieth century, uric acid has been suggested as a risk factor for cardiovascular diseases [1]. While epidemiologic studies suggested that hyperuricemia (HU) is strongly correlated with cardiovascular disease, it is still unclear whether hyperuricemia is an independent risk factor of cardiovascular disease [2]. Some clinical evidence has found a significant and specific association between serum uric acid levels and coronary atherosclerosis; however, there is much controversy concerning this relationship, and some studies in fact came to the opposite conclusions [2, 3]. High uric acid levels could potentially increase the risk of cardiovascular disease via several biological mechanisms; however, recent studies have suggested that endothelial dysfunction is a fundamental mechanism whereby uric acid may affect cardiovascular function. Series of animal experiments revealed that in rats, hyperuricemia induced by oxonic acid, a uricase inhibitor, causes hypertension and renal arteriolopathy and impairs nitric oxide generation [4]. Moreover, oxidative stress plays an important role in the vascular endothelial dysfunction of hyperuricemia [4, 5]. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor [6]. An increase
The independent association between parathyroid hormone levels and hyperuricemia: a national population study
Janet Y Hui, Jee Woong J Choi, David B Mount, Yanyan Zhu, Yuqing Zhang, Hyon K Choi
Arthritis Research & Therapy , 2012, DOI: 10.1186/ar3769
Abstract: By using data from 8,316 participants aged 18 years and older in the National Health and Nutrition Examination Survey 2003 to 2006, we examined the relation between serum PTH and SUA levels with weighted linear regression. Additionally, we examined the relation with hyperuricemia by using weighted logistic regression.SUA levels increased with increasing serum PTH concentration. After adjusting for age, sex, dietary factors, glomerular filtration rate (GFR), and other potentially related biomarkers (calcium, phosphorus, alkaline-phosphatase, 25-hydroxyvitamin D), the SUA level differences from the bottom (referent) to top quintiles of serum PTH levels were 0, 8, 13, 14, and 19 μM (95% CI, 12 to 26; P for trend, < 0.001). These estimates were larger among renally impaired individuals (multivariate SUA difference between the extreme quintiles of PTH, 26 versus 15 μM among those with GFR ≥ 60 versus < 60 ml/min per 1.73 m2, respectively) (P for interaction = 0.004). The odds of hyperuricemia by various definitions increased with increasing PTH levels as well (multivariate P values for trend, < 0.05).These nationally representative data indicate that serum PTH levels are independently associated with serum uric acid levels and the frequency of hyperuricemia at the population level.Hyperuricemia is the precursor of gout, a common and painful inflammatory arthritis with a growing disease burden [1]. Hyperuricemia and gout have been long observed to occur with an increased frequency among patients with hyperparathyroidism, whereas parathyroidectomy is known to reduce serum uric acid levels in these cases [2-7]. Elevated parathyroid hormone (PTH) levels are thought to reduce renal urate excretion, although the exact mechanism remains unclear [7]. Furthermore, recent randomized controlled trials have also found that hyperuricemia or gout is associated with use of teriparatride, a recombinant human PTH approved for osteoporotic fracture prevention [8-10]. After cessation of te
The prevalence of hyperuricemia in China: a meta-analysis
Liu B, Wang T, Zhao HN, Yue WW, Yu HP, Liu CX, Yin J, Jia RY, Nie HW
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-832
Abstract: Epidemiological investigations on hyperuricemia in China published in journals were identified manually and on-line by using CBMDISC, Chongqing VIP database and CNKI database. Those Reported in English journals were identified using MEDLINE database. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. The fixed effects model or random effects model was employed according to statistical test for homogeneity.Fifty-nine studies were selected, the statistical information of which was collected for systematic analysis. The results showed that the pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%), but it was only 8.6% (95%CI: 8.2%-10.2%) in female. It was found that thirty years was the risk point age in male and it was fifty years in female.The prevalence of hyperuricemia is different as the period of age and it increases after 30 years in male and 50 in female. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female.Hyperuricemia (HU) is a result of multifactor interactions including gender, age, genetic and environmental factors. Classically, the following conditions are associated with HU: alcoholism, obesity, hypertension, dyslipidemia, hyperglycemia, diabetes mellitus, lithiasis, renal failure, and medication use (diuretics, cyclosporine, low-dose aspirin) [1]. In the past several decades, the prevalence varied greatly and appeared to be increasing. There was lots information that demonstrated the importance of serum uric acid to the clinical prognosis, so the importance of HU is increasing. It reported that 18.8% of the patients with HU developed into gout in a 5 year follow-up [2]. Independent association between HU and cardiovascular disease has been found in many studies [3,4]. Hyperuricemia has been reported to be associated with several components of metabolic syndrome (MetS) and authors have postulated that increased concent
Allopurinol Reduces the Lethality Associated with Acute Renal Failure Induced by Crotalus durissus terrificus Snake Venom: Comparison with Probenecid  [PDF]
Rodrigo Frezzatti,Paulo Flavio Silveira
PLOS Neglected Tropical Diseases , 2011, DOI: 10.1371/journal.pntd.0001312
Abstract: Background Acute renal failure is one of the most serious complications of envenoming resulting from Crotalus durissus terrificus bites. This study evaluated the relevance of hyperuricemia and oxidative stress and the effects of allopurinol and probenecid in renal dysfunction caused by direct nephrotoxicity of C. d. terrificus venom. Methodology/Principal Findings Hematocrit, protein, renal function and redox status were assessed in mice. High ratio of oxidized/reduced glutathione and hyperuricemia induced by C. d. terrificus venom were ameliorated by both, allopurinol or probenecid, but only allopurinol significantly reduced the lethality caused by C. d. terrificus venom. The effectiveness of probenecid is compromised probably because it promoted hypercreatinemia and hypocreatinuria and worsed the urinary hypo-osmolality in envenomed mice. In turn, the highest effectiveness of allopurinol might be due to its ability to diminish the intracellular formation of uric acid. Conclusions/Significance Data provide consistent evidences linking uric acid with the acute renal failure induced by C. d. terrificus venom, as well as that this envenoming in mice constitutes an attractive animal model suitable for studying the hyperuricemia and that the allopurinol deserves to be clinically evaluated as an approach complementary to anti-snake venom serotherapy.
Valor pronóstico de la hiperuricemia en la insuficiencia cardíaca crónica Prognostic value of hyperuricemia in chronic heart failure  [cached]
Alejandro Martínez S,Alejandro González M,Cristián Cerda D,Pedro Pérez C
Revista médica de Chile , 2004,
Abstract: Background: Hyperuricemia has been proposed as a risk marker in chronic heart failure, but its value as an independent prognostic is not well established. Aim: To determine the prognostic value of hyperuricemia, in patients with chronic stable heart failure. Patients and methods: Forty six male patients with chronic heart failure, aged 62±13 years, were studied. Their ejection fraction was less than 40% and their serum creatinine was less than 2 mg/dl. Serum uric acid and catecholamines, maximal oxygen consumption (VO2 max) and left ventricular ejection fraction were measured. Mortality and the need for cardiac transplant were recorded as endpoints during a mean follow up of 39±18 months. The relationship between basal measures and the occurrence of events was analyzed using univariate and multivariate methods. Results: Basal VO2 max and left ventricular ejection fraction were 16±4.6 ml/kg/min and 22±7% respectively. Eighteen patients died and three required transplantation during the follow up. Patients reaching these endpoints had a lower VO2 max and left ventricular ejection fraction and higher uric acid levels. Multivariate analysis accepted left ventricular ejection fraction (relative risk 0.89, 95% CI 0.82-0.97) and serum uric acid (relative risk 1.335 95% CI 1.02-1.74) as significant predictors of events. The relative risk for cardiac transplantation was 7.07 times higher among those with a serum uric acid over 7 mg/dl. Conclusions: A high serum uric acid is an independent predictor of bad prognosis in patients with stable chronic heart failure (Rev Méd Chile 2004; 132: 1031-6
Preventing acute renal failure is crucial during acute tumor lysis syndrome
Darmon Michael,Thiery Guillaume,Azoulay Elie
Indian Journal of Critical Care Medicine , 2007,
Abstract: Tumour Lysis syndrome (TLS) is characterized by the massive destruction of tumoral cells and the release in the extracellular space of their content. While TLS may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms and cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. Moreover, TLS may lead to an acute renal failure (ARF). In addition to the hospital mortality induced by the acute renal failure itself, development of an ARF may preclude optimal cancer treatment. Therefore, prevention of the acute renal failure during acute tumor lysis syndrome is mandatory. The objective of this review is to describe pathophysiological mechanisms leading to acute tumor lysis syndrome, clinical and biological consequences of this syndrome and to provide up-to-date guidelines to ensure prevention and prompt management of this syndrome.
Use of remote sensing and a geographical information system in a national helminth control programme in Chad
Brooker,Simon; Beasley,Michael; Ndinaromtan,Montanan; Madjiouroum,Ester Mobele; Baboguel,Marie; Djenguinabe,Elie; Hay,Simon I.; Bundy,Don A.P.;
Bulletin of the World Health Organization , 2002, DOI: 10.1590/S0042-96862002001000006
Abstract: objective: to design and implement a rapid and valid epidemiological assessment of helminths among schoolchildren in chad using ecological zones defined by remote sensing satellite sensor data and to investigate the environmental limits of helminth distribution. methods: remote sensing proxy environmental data were used to define seven ecological zones in chad. these were combined with population data in a geographical information system (gis) in order to define a sampling protocol. on this basis, 20 schools were surveyed. multilevel analysis, by means of generalized estimating equations to account for clustering at the school level, was used to investigate the relationship between infection patterns and key environmental variables. findings: in a sample of 1023 schoolchildren, 22.5% were infected with schistosoma haematobium and 32.7% with hookworm. none were infected with ascaris lumbricoides or trichuris trichiura. the prevalence of s. haematobium and hookworm showed marked geographical heterogeneity and the observed patterns showed a close association with the defined ecological zones and significant relationships with environmental variables. these results contribute towards defining the thermal limits of geohelminth species. predictions of infection prevalence were made for each school surveyed with the aid of models previously developed for cameroon. these models correctly predicted that a. lumbricoides and t. trichiura would not occur in chad but the predictions for s. haematobium were less reliable at the school level. conclusion: gis and remote sensing can play an important part in the rapid planning of helminth control programmes where little information on disease burden is available. remote sensing prediction models can indicate patterns of geohelminth infection but can only identify potential areas of high risk for s. haematobium.
Use of remote sensing and a geographical information system in a national helminth control programme in Chad  [cached]
Brooker Simon,Beasley Michael,Ndinaromtan Montanan,Madjiouroum Ester Mobele
Bulletin of the World Health Organization , 2002,
Abstract: OBJECTIVE: To design and implement a rapid and valid epidemiological assessment of helminths among schoolchildren in Chad using ecological zones defined by remote sensing satellite sensor data and to investigate the environmental limits of helminth distribution. METHODS: Remote sensing proxy environmental data were used to define seven ecological zones in Chad. These were combined with population data in a geographical information system (GIS) in order to define a sampling protocol. On this basis, 20 schools were surveyed. Multilevel analysis, by means of generalized estimating equations to account for clustering at the school level, was used to investigate the relationship between infection patterns and key environmental variables. FINDINGS: In a sample of 1023 schoolchildren, 22.5% were infected with Schistosoma haematobium and 32.7% with hookworm. None were infected with Ascaris lumbricoides or Trichuris trichiura. The prevalence of S. haematobium and hookworm showed marked geographical heterogeneity and the observed patterns showed a close association with the defined ecological zones and significant relationships with environmental variables. These results contribute towards defining the thermal limits of geohelminth species. Predictions of infection prevalence were made for each school surveyed with the aid of models previously developed for Cameroon. These models correctly predicted that A. lumbricoides and T. trichiura would not occur in Chad but the predictions for S. haematobium were less reliable at the school level. CONCLUSION: GIS and remote sensing can play an important part in the rapid planning of helminth control programmes where little information on disease burden is available. Remote sensing prediction models can indicate patterns of geohelminth infection but can only identify potential areas of high risk for S. haematobium.
Serum uric acid as an index of impaired renal function in congestive heart failure
Yu Tian,Ying Chen,Bao Deng,Gang Liu
老年心脏病学杂志(英文版) , 2012,
Abstract: Background Hyperuricemia is frequently present in patients with heart failure. Many pathological conditions, such as tissue ischemia, renal function impairment, cardiac function impairment, metabolic syndrome, and inflammatory status, may impact uric acid (UA) metabolism. This study was to assess their potential relations to UA metabolism in heart failure. Methods We retrospectively assessed clinical charac teristics, echocardiological, renal, metabolic and inflammatory variables selected on the basis of previous evidence of their involvement in cardiovascular diseases and UA metabolism in a large cohort of randomly selected adults with congestive heart failure (n = 553). By clustering of indices, those variables were explored using factor analysis. Results In factor analysis, serum uric acid (SUA) formed part of a principal cluster of renal functional variables which included serum creatinine (SCr) and blood urea nitrogen (BUN). Univariate correlation coefficients between variables of patients with congestive heart failure showed that the strongest correlations for SUA were with BUN (r = 0.48, P < 0.001) and SCr (r = 0.47, P < 0.001). Conclusions There was an inverse relationship between SUA levels and measures of renal function in patients with congestive heart failure. The strong correlation between SUA and SCr and BUN levels suggests that elevated SUA concentrations reflect an impairment of renal function in heart failure.
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