Profile of Patients with Acute Renal Injury in N’Djamena: About 36 Cases

Abstract

Introduction: The incidence of acute renal injury (AKI) has increased in recent decades. Acute renal failure is defined by the abrupt arrest (within hours or days) of the kidney excretory function. Oliguria (urine output <400 ml/ 24h) is present ed in about half of the cases. The circumstances of the occurrence of AKI are multiple: surgical, traumatic, obstetric, medical, often obvious. Its prognosis depends on the speed of management and the associated organ failure. The objective of this study is to describe the profile of patients in emergency hemodialysis at the Nephrology Unit of the National Reference General Hospital (HGRN) in N’Djamena, Chad. Methods: This was a multicenter, descriptive study in patients with acute renal failure place over a period of 12 months in the emergency departments of the 2 hospitals in N’Djamena. Defined as carriers of an AKI (RIFLE criteria), patients with: 1) Oliguria: urinary output < 400 ml/24h (<0.5 ml/kg/h in children) or anuria: urinary output < 300 ml/24h; 2) Associated with an increase in serum creatinine: serum creatinine × 3 or serum creatinine> 350 μmol/l or decrease of GFR by 75%. Results: Of the 311 patients admitted, 36 cases met the inclusion criteria, a frequency of 11.57%. The mean age was 34.46 years with extremes ranging from 7 to 80 years. The female sex predominated with 52.80% as sex ratio of 0.91. Isolated hypertension was noted with 38.88%. Dyspnea accounted for 41.66% of patients admitted to emergency departments. In our series, 50% of our patients had hyperthermia at admission. Oliguria was observed in 41.70% of the cases. Edema accounted for 33.33% of cases. The AKI with the “ failure ” criterion was 58.34% (21/36), with the criterion “injury” 25% (9 cases) and the criterion “risk” 16.66 (6 cases). AKI were organic in 83 . 34% (30/36). It was noted that 14 patients, 38.8% had an infectious syndrome. There were 6 patients who had (16.66%) an obstructive AKI, 5 patients (13.88%) had eclampsia, 4 patients (11.12%) had hepatocellular insufficiency, 3 patients (8.34% Cardiac, 2 patients (5.56%) extracellular dehydration and 2 patients (5.56%) whose cause is indeterminate. It was noted that 10 patients, as 27.7%, had fully recovered their renal function after vascular filling and etiological treatment. Four (4) patients with obstructive obstruction were referred to the urology department. There were 22 patients who had benefited from the hemodialysis. 6 patients recovered completely their renal function. We had recorded a number of deaths in our study which was 44.44% (16/36). Septic shock was the most frequent cause of death in 50% of cases. Conclusion: The incidence of AKI in our study was 11.57%. It affects a young population and despite the therapeutic progress, the mortality remains high. The causes are multiple, entangled, dominated by infectious syndrome and hypovolemia. Prevention seems to be the best therapeutic option to avoid the installation or worsening of an AKI.