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A 65-year-old man who received a deceased renal allograft in September 2001. The donor of the allograft was a 54-year-old hypertensive man who expired from intracerebral hemorrhage. Atheroma with hard plaques was present in both renal arteries and aortic patches. After vascular anastomosis and clamp release, the allograft recolo-ration was inadequate, and the patient remained anuric. Computerized tomography scan demonstrated disseminated infarction areas, suggesting cholesterol emboli, which was confirmed later by a graft biopsy. As approximately 50% of the renal parenchyma was perfused, graft nephrectomy was not indicated and dialysis was restarted. Diuresis was over 3000 ml/day and serum creatinine decreased and stabilized at 360 µmol/L by the 32 nd postoperative day. The allograft supported the patient for only two years, and he eventually was successfully retransplanted in June 2003. We believe that delayed graft function due to cholesterol emboli disease may be reversible if areas of infarction are not too large.

This study was conducted in order to identify the failure rate of the first arterio-venous fistula (AVF) in patients starting hemodialysis (HD) with a central venous catheter (CVC) and to search for factors responsible for this failure. A retrospective study was conducted on 85 patients on chronic HD in Abidjan, from March 15 th to April 15 th , 2007. Factors that could poten-tially influence the failure of the first AVF were collected. Statistical analysis was used for com-parison between groups. Among the study subjects, 7.14% had AVF at the start of their dialysis as against 92.86% who had CVC. About 50% of the patients starting dialysis with CVC failed to have an AVF created within 90 days of commencing dialysis. The number of catheters inserted was significantly higher in patients with failed first AVF as compared to their counterparts (49.29 % versus 30.77%) (p< 0.001). Similarly, the number of attempts at AVF creation, within 90 days of starting HD, was significantly higher in patients with failed first AVF (81.48% versus 18.52%) (p< 0.001). Multivariate analysis did not reveal any specific factor(s) that influenced the failure rate of the first AVF. Our study suggests that a very small number of patients in Ivory Coast started dialysis with an AVF. The failure rate of the first AVF in patients starting dialysis on CVC is about 50%.

The prevalence of chronic renal failure (CRF) in sickle cell disease (SCD) patients could vary from one country to another depending on the modalities of management. The aim of the present study was to appreciate the epidemiology of CRF in SCD patients from black Africa in order to search for promoting factors. One hundred SCD adult patients have been considered for the study. The glomerular filtration rate (GFR) has been estimated according to the CKD-EPI formula. Three groups of patients have been identified according to the value of their GFR. The mean age of the patients was 30.84±8.26 years. Male gender has represented 51% of the study population. The mean GFR value was 175.4±86.2 mL/min/1.73 m(2). The prevalence of CRF was 11%. About 3% of them had severe CRF. Subjects with normal GFR were 20%. Subjects with glomerular hyperfiltration (HF) were 69%. By univariate analysis, when subjects with HF were compared with those presenting normal GFR, the following factors have appeared to be significantly associated: female gender (female 60.9% versus male 39.1%; P<0.01), weight <60 kg (weight <60 kg; 53.67±9.45 kg versus weight >60 kg; 59.9±9.41 kg; P<0.008), age <30 years (younger age 29.36±7.9 years versus older age 35.14±8.02 years; P<0.001), lower hemoglobin value (9.38±2,3 g/dL versus 10.33±2.61 g/dL; P<0.04). By logistic regression analysis, age <30 years (age >30 years; OR=0.12 [CI95% 0.03-04]; P<0.001), female gender (male gender; OR=0.17 [0.04-0.64]; P<0.01), weight <60 kg (weight >60 kg; OR=0.19 [CI95% 0.05-0.72]; P<0.01) were associated with HF. By univariate analysis, when subjects with CRF were compared with those presenting normal GFR, a lower hemoglobin value was significantly associated with CRF (7.92±2.7 g/dL versus 10.43±2.5 g/dL; P<0.009). There was a trend for subjects not being under maintenance therapy to more experience CRF (36.4% versus 70%; P<0.07). By logistic regression analysis, only a low hemoglobin value was associated to CRF (higher hemoglobin level; OR=0.55 [0.20-6.3]; P<0.01). In total, CRF and HF are frequent complications in SCD adult patients from black Africa., (Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently., (Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

The source of living kidney donors in the general population remains underused. The present study aims at assessing the prevalence and the characteristics of potential living kidney donors in Ivory Coast in a view of a project of kidney transplantation in French Black Africa. A survey was undertaken in Abidjan from 30 June to 7 July 2006. Nine hundred (and) sixty-two subjects living in the capital and aged between 19 and 64 years old were randomly chosen using data from the 1998 population census. Subjects were asked their age, gender, nationality, marital status, information on kidney graft and renal failure, and their willingness to donate kidney to a relative or friend for transplantation purpose. Seventy per cent of the population study appeared favourable to kidney donation. Potentials living kidney donors have displayed following characteristics: age inferior to 26 years old [OR=2.08, P<0.02, 95%CI: 1.10-3.92]; Ivorians national [OR=2.72, P<0.002, 95% CI 1.42-5.21]; having heard of kidney transplantation (OR=1.89, P<0.047, 95% CI 1-3.54]); the death of a relative or friend from renal failure [OR=1.82, P<0.002, 95% CI 1.25 2.67]. Being married adversely affect kidney donation [OR=0.52, P<0.0002, 95% CI 0.34-0.79]. Potentials living kidney donors are in great number in Ivory Coast, who had specific characteristics.

Background: Little is known about vascular access infections in patients with acute renal failure., Methods: We prospectively compared infection rates of dialysis catheters (DCs) and central venous catheters (CVCs) in patients in the intensive care unit treated with renal replacement therapy for acute renal failure. The same insertion and maintenance procedures were used for CVCs and DCs. To circumvent the allocation bias caused by severity of patient condition, only patients with both types of catheters were included., Results: A total of 150 CVCs and 130 DCs were analyzed in 99 patients with a mean Simplified Acute Physiology Score II of 67 +/- 21. The major cause of acute renal failure was sepsis (62%). Hospital mortality was 62%. Mean catheter duration was shorter for DCs (6.7 +/- 4.4 days) than CVCs (7.8 +/- 4.9 days; P = 0.03). There was no difference between CVCs and DCs in cumulative incidence of catheter colonization (quantitative catheter cultures > or = 10(3) colony-forming units/mL; 4.7% versus 6.2%; P = 0.58) or incidence density of catheter colonization per 1,000 catheter days (5.9 versus 9.1; P = 0.44, respectively). There also was no difference between CVCs and DCs in cumulative incidence and incidence density regardless of whether catheters were placed at the internal jugular (P = 0.34 and P = 0.23) or femoral site (P = 0.57 and P = 0.80), respectively. Three cases of CVC-related bacteremia (the same microorganism responsible for both catheter colonization and blood culture result) were recorded, but none with DC use., Conclusion: When severity of patient condition is controlled for, epidemiological characteristics of colonization in CVCs and DCs are similar if similar infection control measures are used for insertion and maintenance.