Clinical, Etiological and Progressive Aspects of Acute Tubular Necrosis of Toxic Origin at the Brazzaville University Hospital Center

Abstract

Background and Objectives: Acute tubular necrosis (ATN) is the second cause of acute kidney injury (AKI) in an intra-hospital environment. The toxic origin is avoidable. Our objectives were to determine the toxic substances at the origin of ATN at the Brazzaville University Hospital and determine the evolving aspects and the factors associated with it. Patients and Methods: We carried out a 12-month from June 20, 2022 to June 30, 2023. It was a prospective observational study in the Nephrology Department of Brazzaville University Hospital Center. The diagnosis of ATN was done in the presence of AKI occurring in the context of taking nephrotoxic substances with negative albuminuria. Cases of ATN aggravating CKD were excluded. Data analysis was done with Epi-Info 7.2 software. Results: We identified 63 cases of AKI on toxic ATN. Their average age was 47 ± 19 years with a male predominance of 60.2%. The 3 main toxicants incriminated were: herbal medicine (49.2%), Gentamycin (17.5%) and non-steroidal anti-inflammatory drugs (14.3%). An indication for hemodialysis was made in 43 patients (68.2%), the evolution was marked by a cure in 29 patients (46.1%), 10 (15.9%) became chronic kidney failure, 19 (30.1%) died, 5 (7.9%) were lost to follow-up. The main factor for non-healing is anuria (p < 0.001) and diabetes (p < 0.001). Conclusion: The main cause of toxic ATN at Brazzaville University Hospital is herbal medicine. The death rate is high there.