Acute Obstructive Renal Failure at the University Hospital of Brazzaville from Epidemiology to Therapy

Abstract

Introduction: Acute obstructive renal failure (AORF) is a life-threatening medical and surgical emergency. The aim of our work is to describe the clinical, biological, echographic, etiological and therapeutic profile of AORF. Patients and methods: This is a retrospective and descriptive study spanning a period of 15 months (from January 1, 2022 to March 15, 2023) collecting cases of IRAO among the files of patients hospitalized in nephrology and dialysis at the CHU/B. Results: We have 35 patients out of 615 or 5.69% of the population studied. The mean age of the patients was 62.6 years (range: 22 - 88 years). The sex ratio was 3 men for one woman. The circumstances of discovery were dominated by pelvic pain at 37.14%. The mean diuresis was estimated at 966 ml per 24 hours (range: 0 - 3000). The obstacle was prostatic in 45.71%, tumoral in 14.28%; lithiasis 17.14%; and undetermined for 25.71%. The mean creatinine level was 111.9 mg/L (range: 11 - 325). Renal ultrasound showed dilated urinary cavities in 31.42% of cases; dilatation was bilateral in 25.71% of cases. The indication for hemodialysis was: uremic syndrome, threatening hyperkalemia and acute pulmonary edema in 37.14%; 5.71% and 2.85% respectively. Bladder catheterization or suprapubic catheterization was performed in 100% of cases and allowed the removal of the obstacle and immediate resumption of diuresis. Joint urological management consisted of the placement of a percutaneous nephrostomy tube in 8.57% of cases, and the insertion of the double J tube. The evolution was marked by 8.57% deaths. Conclusion: The incidence of IRAO at the Brazzaville University Hospital is 5.69%, with a predominance of prostatic obstruction. Emergency therapeutic management is mainly based on drainage of the urinary tract, followed later by treatment of the causal pathology. The delay in consultation and the delay in performing the nephrostomy and double J catheterization constitute an obstacle to the recovery of normal renal function and vital prognosis.