[Collaboration in nephrology between Geneva and Yaoundé: a convincing example]

Chronic kidney disease (CKD) has a high prevalence in Cameroon and will become an important public health problem. Its management must be comprehensive, starting with CKD prevention to the implementation of renal replacement therapies best suited to the needs of patients and resources available in Cameroon. Practical interventions involving nephrology departments in both Africa and Europe can contribute to an improved management of CKD in Africa. The current collaboration between the Geneva University Hospitals and the Yaoundé teaching hospitals is a convincing example. It includes a clinical trial on the treatment of metabolic acidosis linked to CKD, assistance with the placement of hemodialysis catheters by sonography and the initiation of a kidney transplantation program with living donors.

[When an adrenal crisis disguises itself as a viral gastroenteritis]

A 44-year-old patient was admitted to the emergency department for uncontrollable vomiting, weakness, and headache. His medical history included regular episodes of migraines and traumatic brain injury at the age of 11. Upon admission, the patient was confused with stable vital signs. The epigastrium was slightly sensitive. Additional examinations (ECG and laboratory analysis) were unremarkable, and clinicians thought it was gastroenteritis. A detailed interview revealed that the patient had been taking daily hydrocortisone to treat panhypopi-tuitarism secondary to past traumatic brain injury. The diagnosis of stress-induced adrenal insufficiency was finally retained.

[Cognitive bias in the context of epidemic]

In connection with the scope and duration of the COVID-19 pandemic, the clinical judgement of clinicians and medical practitioners could be influenced such that diagnostic errors (delays and inaccuracies) may ensue. We hereby recall through two clinical scenarios the constant need for practitioners to take a step back in reflecting of the diagnostic process to avoid the « tunnel effect » which may result in delaying common and frequent infectious diseases. The flu-like symptoms presented by these patients (fever, myalgia and asthenia…) quickly prompted our emergency room colleagues to suspect SARS-CoV-2 infection. However, further investigations including imagery and blood cultures revealed completely different but common infectious disease conditions, which are potentially fatal.

[Diuretics in acute kidney failure: useful or harmful?]

Loop diuretics are commonly prescribed within different clinical settings to prevent and or to treat acute renal failure. In most cases they facilitate fluid management following an increased urine output. Experimental models in animals revealed protective effects of loop diuretics in acute renal failure. Several clinical trials have failed to outline better outcomes associated with the use of diuretics in acute renal failure as there was no recovery in renal function nor a reduction in the number of dialysis sessions required. Glomerular filtration rate did not improve with the administration of loop diuretics after continuous renal replacement therapy. The administration of loop diuretics in the management of acute renal failure should be mainly restricted to patients with hypervolemia.