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1.
Adv Gerontol ; 32(4): 614-626, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800192

RESUMO

Aging causes significant changes in the kidneys. One of the most important manifestations of an aging kidney is a reduction in glomerular filtration rate (GFR). Unfortunately, there is no generally accepted, adequate method for evaluating GFR in the elderly. The perspectivies of the relatively new approaches (BIS1, BIS2, FAS) are not clear and doubtful. The feasibility of standardization of GFR values by body surface area among of the older persons has not been determined. Possible that the diagnosis setting «chronic kidney disease¼ in elderly solely on the base of GFR decline may be an inadequate approach and promote a kind of «nephrological ageism¼.


Assuntos
Envelhecimento , Taxa de Filtração Glomerular , Rim , Idoso , Idoso de 80 Anos ou mais , Humanos , Rim/metabolismo , Rim/patologia , Testes de Função Renal/normas , Insuficiência Renal Crônica/diagnóstico
3.
Vasc Health Risk Manag ; 15: 365-373, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31686830

RESUMO

Chronic kidney disease (CKD) has become a major public health problem in the USA and worldwide. A large majority of patients with CKD have mild to moderate disease and microalbuminuria. It has increasingly been noted that patients with CKD have a significantly higher risk of cardiovascular outcomes compared to patients with normal kidney function. Many studies have shown increased risk beginning at stage 3 CKD but risk has been elevated in patients with milder degrees of kidney dysfunction in some studies. This risk may be better predicted by the degree of albuminuria in the earlier stages of CKD. Data addressing interventions to improve outcomes in patients with mild to moderate CKD are scarce. In this paper, we examined data and post hoc analyses from the ORIGIN and ACCORD trials. Data indicate that intensive treatment of diabetes in patients with CKD actually may result in adverse outcomes. The mechanism by which CKD results in increased cardiovascular risk is not clear. Patients with CKD frequently have the traditional risk factors that cause cardiovascular disease and there are mechanisms that are unique to CKD that promote the development of cardiovascular disease. In this article, we describe in some detail traditional, newer and novel risk factors that play a role in the development of CKD and heart disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/mortalidade , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/mortalidade , Humanos , Hipoglicemiantes/efeitos adversos , Prognóstico , Proteinúria/epidemiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Medição de Risco , Fatores de Risco
4.
Nat Med ; 25(11): 1753-1760, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700174

RESUMO

Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.


Assuntos
Doenças Cardiovasculares/diagnóstico , Taxa de Filtração Glomerular/fisiologia , Falência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Albuminúria/complicações , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Albuminúria/urina , Bancos de Espécimes Biológicos , Biomarcadores/sangue , Biomarcadores/urina , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Creatinina/metabolismo , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco
5.
Braz J Med Biol Res ; 52(11): e8333, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721901

RESUMO

Not much is known about the roles of long non-coding RNAs (lncRNAs) for chronic kidney disease (CKD). In this study, we included CKD patient cohorts and normal controls as a discovery cohort to identify putative lncRNA biomarkers associated with CKD. We first compared the lncRNA expression profiles of CKD patients with normal controls, and identified differentially expressed lncRNAs and mRNAs. Co-expression network based on the enriched differentially expressed mRNAs and lncRNAs was constructed using WGCNA to identify important modules related to CKD. A lncRNA-miRNA-mRNA pathway network based on the hub lncRNAs and mRNAs, related miRNAs, and overlapping pathways was further constructed to reveal putative biomarkers. A total of 821 significantly differentially expressed mRNAs and lncRNAs were screened between CKD and control samples, which were enriched in nine modules using weighted correlation network analysis (WGCNA), especially brown and yellow modules. Co-expression network based on the enriched differentially expressed mRNAs and lncRNAs in brown and yellow modules uncovered 7 hub lncRNAs and 53 hub mRNAs. A lncRNA-miRNA-mRNA pathway network further revealed that lncRNAs of HCP5 and NOP14-AS1 and genes of CCND2, COL3A1, COL4A1, and RAC2 were significantly correlated with CKD. The lncRNAs of NOP14-AS1 and HCP5 were potential prognostic biomarkers for predicting the risk of CKD.


Assuntos
Marcadores Genéticos/genética , RNA Longo não Codificante/genética , RNA Mensageiro/genética , Insuficiência Renal Crônica/genética , Estudos de Casos e Controles , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Prognóstico , Insuficiência Renal Crônica/diagnóstico
6.
Pan Afr Med J ; 33: 321, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692795

RESUMO

Introduction: The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. Methods: We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. Results: We interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ). History of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. Conclusion: Burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.


Assuntos
Hematúria/epidemiologia , Falência Renal Crônica/epidemiologia , Proteinúria/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Pacientes Internados , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Inquéritos e Questionários
7.
JAMA ; 322(13): 1294-1304, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573641

RESUMO

Importance: Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death. Observations: Defined as a persistent abnormality in kidney structure or function (eg, glomerular filtration rate [GFR] <60 mL/min/1.73 m2 or albuminuria ≥30 mg per 24 hours) for more than 3 months, CKD affects 8% to 16% of the population worldwide. In developed countries, CKD is most commonly attributed to diabetes and hypertension. However, less than 5% of patients with early CKD report awareness of their disease. Among individuals diagnosed as having CKD, staging and new risk assessment tools that incorporate GFR and albuminuria can help guide treatment, monitoring, and referral strategies. Optimal management of CKD includes cardiovascular risk reduction (eg, statins and blood pressure management), treatment of albuminuria (eg, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers), avoidance of potential nephrotoxins (eg, nonsteroidal anti-inflammatory drugs), and adjustments to drug dosing (eg, many antibiotics and oral hypoglycemic agents). Patients also require monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Those at high risk of CKD progression (eg, estimated GFR <30 mL/min/1.73 m2, albuminuria ≥300 mg per 24 hours, or rapid decline in estimated GFR) should be promptly referred to a nephrologist. Conclusions and Relevance: Diagnosis, staging, and appropriate referral of CKD by primary care clinicians are important in reducing the burden of CKD worldwide.


Assuntos
Insuficiência Renal Crônica , Complicações do Diabetes/tratamento farmacológico , Progressão da Doença , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Prognóstico , Encaminhamento e Consulta , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Medição de Risco
8.
Rev Med Suisse ; 15(662): 1629-1632, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508915

RESUMO

Arterial hypertension (HT) affects hundreds millions of people suffering from chronic kidney disease: it could be a cause or a consequence. HT can aggravate their prognosis and then lead to a very high cardiovascular morbidity and mortality. HT must be systematically screened and optimally taken care of. However, general practitioners actually lack unambiguous guidelines regarding patients with kidney diseases. This article underlines the necessity and modalities of a precise diagnosis, and aims to discuss the last studies supporting new and better therapeutic targets. The pathophysiological aspects of HT in chronic kidney diseases are also discussed.


Assuntos
Hipertensão/complicações , Hipertensão/terapia , Insuficiência Renal Crônica/complicações , Humanos , Hipertensão/mortalidade , Guias de Prática Clínica como Assunto , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Fatores de Risco
9.
Acute Med ; 18(3): 138-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536049

RESUMO

Reduced kidney function, whether acute or chronic, is a highly significant biomarker of in most clinical settings. This is particularly true on the acute medical take where altered renal function is associated with a worse prognosis, and may also impact on immediate management strategies such as drug choice, dosing and suspension, and the use of contrast agents for imaging. In this edition of the Acute Medical Journal, Yang et al present the results of their study describing the renal function and associated characteristics in 2,070 consecutive patients presenting on the unselected medical take at their hospital over a 40 day period. In this study, the authors provide a wealth of information on the general characteristics of acute medical patients admitted with altered kidney function, be it CKD or AKI. Importantly, both chronic kidney disease (CKD) and acute kidney injury (AKI) are very highly prevalent. Indeed, in this study more than 5% of all medical admissions actually demonstrated evidence of both.


Assuntos
Lesão Renal Aguda , Insuficiência Renal Crônica , Lesão Renal Aguda/diagnóstico , Biomarcadores , Hospitalização , Humanos , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco
10.
Zhonghua Er Ke Za Zhi ; 57(9): 669-673, 2019 Sep 02.
Artigo em Chinês | MEDLINE | ID: mdl-31530351

RESUMO

Objective: To analyze diagnosis rate of chronic kidney disease (CKD) in hospitalized pediatric patients in a single center and understand pediatricians' awareness of CKD. Methods: This was a cross-sectional study. Children who were admitted to the Division of Pediatric Nephrology, Peking University First Hospital from January 1, 2008 to December 31, 2017 and met the diagnostic criteria of CKD (kidney disease: improving global outcomes 2012 guideline) were recruited. A total of 4 472 cases were enrolled. Original CKD diagnosis was collected from the home page of medical records. Actual CKD diagnosis was validated and corrected by reviewing medical records and recalculating glomerular filtration rate. The diagnosis rate and influencing factors of pediatric CKD, the distribution and etiology of actual CKD were analyzed. The comparison between groups were performed with χ(2) test. Results: In 4 472 cases, there were 3 470 cases in actual CKD stage 1, among which only 24 cases were in original CKD stage 1. There were 543 cases in actual CKD stage 2-3, among which only 181 cases were in original CKD stage 2-3. Three hundred and one cases were in actual CKD stage 4-5, including 290 cases in original CKD stage 4-5. In addition, there were 43 cases with unknown CKD stage and 115 cases with acute kidney injury. Compared to original CKD diagnosis, the diagnosis rates of CKD stage 1-5 were 0.7% (24/3 470), 16.7% (58/348), 63.1% (123/195), 90.7% (78/86) and 98.6% (212/215), respectively. The proportions of actual CKD stage 1-5 were 80.4% (3 470/4 314), 8.1% (348/4 314), 4.5% (195/4 314), 2.0% (86/4 314) and 5.0% (215/4 314). The etiology of actual CKD included primary glomerular disease (62.2%, 2 686/4 314), secondary glomerular disease (19.7%, 849/4 314), hereditary kidney disease (9.1%, 391/4 314), congenital abnormalities of the kidney and urinary tract (CAKUT) (3.1%, 135/4 314), tubulointerstitial disease (2.2%, 94/4 314) and etiology uncertain (2.1%, 89/4 314). The leading cause of end stage renal disease was etiology uncertain (31.1%, 67/215), followed by hereditary kidney disease (24.2%, 52/215), CAKUT (16.3%, 35/215) and primary glomerular disease (16.3%, 35/215). Conclusions: Among actual CKD hospitalized pediatric patients, the diagnosis rate of CKD given by physicians at discharge was relatively low, especially patients in earlier CKD stages, which reflected serious lack of physicians' awareness of CKD.


Assuntos
Rim/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/epidemiologia , Criança , Estudos Transversais , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Fatores de Risco
11.
Acta Diabetol ; 56(12): 1323-1331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494747

RESUMO

AIMS: Nephropathic patients show higher levels of advanced glycation end products (AGEs) and oxidized human serum albumin (HSAox) compared to healthy subjects. These two classes of compounds are formed as the result of oxidative insults; for this reason, they can be useful oxidative stress biomarkers. The present study examines the variation of AGEs and HSAox in hemodialysis (HD) patients before and after dialysis session, evaluating the impact of different dialytic techniques and filters on their removal. METHODS: A total of 50 healthy subjects (control group) and 130 HD patients were enrolled in the study. Hemodialysis patients were subdivided based on dialytic techniques: 109 in diffusive technique and 22 in convective technique. We monitored HSAox, AGEs and other laboratory parameters at early morning in healthy subjects and in HD patients before and after the dialysis procedures. RESULTS: The level of HSAox decreases after a single dialytic session (from 58.5 ± 8.8% to 41.5 ± 11.1%), but the concentration of total AGEs increases regardless of adopted dialytic techniques (from 6.8 ± 5.2 µg/ml to 9.2 ± 4.4 µg/ml). In our study, levels of HSAox and total AGEs are similar in diabetic and non-diabetic HD patients. The increase in total AGEs after dialysis was only observed using polysulfone filters but was absent with polymethacrylate filters. CONCLUSIONS: HSAox is a simple and immediate method to verify the beneficial effect of a single dialysis session on the redox imbalance, always present in HD patients. Total AGEs assayed by ELISA procedure seem to be a less reliable biomarker in this population.


Assuntos
Biomarcadores , Produtos Finais de Glicação Avançada/sangue , Diálise Renal , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Albumina Sérica Humana/metabolismo , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Casos e Controles , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Produtos Finais de Glicação Avançada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Oxirredução , Estresse Oxidativo/fisiologia , Polímeros/química , Ácidos Polimetacrílicos/química , Prognóstico , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Albumina Sérica Humana/análise , Sulfonas/química , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(33): e16745, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415370

RESUMO

RATIONALE: Malformative uropathies represent a major cause of Chronic Kidney Disease (CKD) in children. Genitourinary system is the most frequent and sever affected in Prune-Belly syndrome cases. That is why the findings of early diagnosis and vigilant monitoring for these situations remain a major challenge for the medical team. PATIENT CONCERNS: We present the clinical course of a 10 years old child with diagnosis of Prune-Belly syndrome. A urinary tract abnormality was suspected starting 25 weeks of gestation, when a routine ultrasound showed oligohydramnios, increased size urinary bladder, bilateral hydronephrosis and megaureters, thin abdominal wall. DIAGNOSIS: Prenatal suspicion of Prune-Belly syndrome plays a deciding role in renal disease progression. A detailed clinical exam at birth established the diagnosis of Prune-Belly syndrome. Renal ultrasound confirmed bilateral grade III hydronephrosis and megaureters, with empty bladder, suggesting an obstruction at this level. A persistent urachus was confirmed by catheterization. Later it was used for imaging study that showed bilateral high grade reflux. INTERVENTIONS: The main goal of any treatment is to preserve kidney function. Treatment options depend on the clinical picture. The pregnancy was closely monitorized, but fetal distress appeared so early labor was induced at 32 weeks. At beginning a temporary catheter was placed into the urachus which expressed urine. The urachus drain was left in place until the age of 6 weeks, when a bilateral ureterostomy was performed. Skeletal and genital malformations were present too; the child has undergone several surgeries to solve these abnormalities. OUTCOMES: At the age of 10 years, he is a well-adapted child. He has had fewer than 3 urinary tract infections per year. Long term follow-up showed a relatively slow decline in the estimated Glomerular Filtration Rate in our child (62 ml/1.73m/min). LESSONS: This case suggests that induced early labor could prove beneficial for early upper urinary tract decompression through earlier access to surgery. This is an option especially in situations or region where vesicoureteric or vesicoamniotic shunt placement is not available.


Assuntos
Síndrome do Abdome em Ameixa Seca/diagnóstico por imagem , Insuficiência Renal Crônica/terapia , Anormalidades Múltiplas , Criança , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Síndrome do Abdome em Ameixa Seca/complicações , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Ultrassonografia Pré-Natal
13.
Medicine (Baltimore) ; 98(33): e16840, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415407

RESUMO

RATIONALE: Twin pregnancy in women with chronic kidney disease (CKD) is very rare but poses a great risk to both mother and children. In developing countries like China, advanced CKD twin pregnancies are often terminated. Here, we report a successful case and reviewed related cases, hope to facilitate further study. PATIENT CONCERNS: A 29-year-old woman with a twin pregnancy showed serum creatinine (Scr) 100 µmol/L (CKD2) at conception. During her 12th week, Scr reached 263 µmol/L (CKD4) with urine protein 3+ and hypertension. DIAGNOSES: Due to her pregnancy, renal biopsy was not considered. Lab tests showed deterioration of renal function and ultrasound detections showed small kidney size. INTERVENTIONS: The patient was given basic drug therapy to control her blood pressure and supplemental nutrition without hemodialysis. OUTCOMES: The patient delivered 2 healthy babies weighting 0.9 and 0.7 kg by cesarean section at the 28th week, but has been under maintenance hemodialysis since then. LESSONS: Despite low birth weight and preterm delivery, successful twin pregnancies in some patients with CKD could be realized under early multidisciplinary intervention, but this poses great risks for mothers and twins, especially for patients with advanced CKD and those on hemodialysis.


Assuntos
Complicações na Gravidez/fisiopatologia , Gravidez de Gêmeos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Cesárea , China , Creatinina/sangue , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Nifedipino/uso terapêutico , Prednisona/uso terapêutico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Vasodilatadores/uso terapêutico
14.
Ann Biol Clin (Paris) ; 77(4): 375-380, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418698

RESUMO

Blood concentration of cystatin C is independent of muscle mass and tubular secretion. It can be used, in the absence of a reference method, as an alternative marker to creatinine for the evaluation of renal function and the estimation of glomerular filtration rate (GFR). Both particle-enhanced immunonephelemetry (PENIA) or immunoturbidimetry (PETIA) methods are available to determine cystatin C. From an analytical point of view, it is recommended to use methods whose calibration is traceable to the reference material (ERM-DA471/IFCC) and to report an estimated GFR based on cystatin C. The main equations used are those developed in 2012 by the group "Chronic kidney disease epidemiology collaboration (CKD-EPI)" for adults and those published by Schwartz in 2012 for children. National and international recommendations suggest using a cystatin C-based GFR estimate as a confirmatory test in the clinical settings where the relationship between creatinine production and muscular mass impairs the clinical performance of creatinine. The indications retained by the working group were graded according to the level of recommendations. The essential indications are the estimation and/or the monitoring of renal function in children and adolescents due to rapid changes in muscle mass; in patients with impaired muscle mass and in patients with an alteration of tubular secretion of creatinine (essentially iatrogenic effects).


Assuntos
Cistatina C/análise , Taxa de Filtração Glomerular , Testes de Função Renal/métodos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Análise Química do Sangue/métodos , Análise Química do Sangue/normas , Criança , Creatinina/sangue , Cistatina C/sangue , Humanos , Testes de Função Renal/normas , Padrões de Referência , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Estatística como Assunto/métodos , Estatística como Assunto/normas
15.
Expert Rev Clin Pharmacol ; 12(9): 867-874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456441

RESUMO

Introduction: Hepatitis B virus is an important cause of liver disease and has numerous extra-hepatic manifestations. HBV leads to important morbidity and mortality in the general population and recent evidence suggests a role of HBV in the incidence and progression of chronic kidney disease. Areas covered: The mechanisms underlying the link between HBV and CKD remain unclear. Nucleos(t)ide analogues for the antiviral treatment of HBV are currently available; these drugs are provided with high efficacy even in patients with CKD. Expert opinion: A recent meta-analysis of clinical studies showed that HBV results in a greater risk of CKD in the general population. According to an updated review (studies were identified from PubMed, EMBASE, and the Cochrane database), we retrieved six clinical studies (n = 1,034,773 unique patients), adjusted RR, 1.41 (95% CI, 1.09; 1.82, P < 0.001). The significant heterogeneity observed precluded more definitive conclusions. Various mechanisms have been cited to explain the greater risk of CKD among HBsAg positive carriers. Novel evidence shows that untreated HBV and therapy with nucleos(t)ide analogues are associated with increased and decreased risk of end-stage renal disease in CKD population, respectively. We recommend that patients with HBV are assessed for kidney function and urinary changes at baseline and over the follow-up.


Assuntos
Antivirais/administração & dosagem , Hepatite B/complicações , Insuficiência Renal Crônica/etiologia , Progressão da Doença , Hepatite B/tratamento farmacológico , Hepatite B/virologia , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Falência Renal Crônica/virologia , Testes de Função Renal , Nucleosídeos/administração & dosagem , Nucleotídeos/administração & dosagem , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/virologia , Fatores de Risco
17.
Biochem Med (Zagreb) ; 29(3): 030704, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31379462

RESUMO

Introduction: The aim of the study is to assess the degree of adherence of medical laboratories to Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) in laboratory practice in Czechia and Slovakia. Materials and methods: An electronic questionnaire on adherence to KDIGO 2012 guideline was designed by an external quality assessment (EQA) provider SEKK spol. s.r.o. The questionnaire was placed and distributed through website to all medical biochemistry laboratories in Czechia and Slovakia (N = 396). Results: A total of 212 out of 396 laboratories responded to the questions, though some laboratories only answered some questions, those applicable to their practice. A total of 48 out of 212 laboratories adopted the KDIGO 2012 guideline in full extent. The metrological traceability of creatinine measurement to standard reference material of SRM 967 was declared by 180 out of 210 laboratories (two of the responding laboratories did not measure creatinine). Thirty laboratories are not well educated on traceability of creatinine measurement and seven laboratories do not calculate estimated glomerular filtration rate (eGFR). Both urinary albumin concentration and albumin to creatinine ratio are reported by 144 out of 175 laboratories (37 of the responding laboratories did not measure urinary albumin). Conclusion: Majority of laboratories in Czechia and Slovakia adopted some parts of the KDIGO 2012 guideline in their practice, but only 23% of the laboratories apply them completely. Thus, further education and action should be conducted to improve its implementation.


Assuntos
Laboratórios Hospitalares/normas , Insuficiência Renal Crônica/diagnóstico , Creatinina/urina , República Tcheca , Taxa de Filtração Glomerular , Guias como Assunto , Humanos , Insuficiência Renal Crônica/patologia , Eslováquia , Inquéritos e Questionários
18.
Molecules ; 24(17)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31454880

RESUMO

The early asymptomatic stage of glomerular injury is a diagnostic challenge in the course of renal and extra-renal disease, e.g., heart insufficiency. It was found that podocin, a podocyte-specific protein present in the urine, may serve as a biomarker in the diagnosis of glomerular disease in humans and animals including glomerulonephritis, glomerulosclerosis, amyloidosis, or nephropathy. Therefore, there is a need of development of the sensitive and straightforward method of urinary podocin identification. In this work, we report our extended research under the glomerular injury investigation in dogs by application of clinical examination and LC-MS-MRM method in the identification of canine podocin in urine samples. The LC-MS-MRM method is based on the identification of podocin tryptic peptide with the 218H-AAEILAATPAAVQLR-OH232 sequence. The model peptide was characterized by the highest ionization efficiency of all the proposed model podocin tryptic peptides in a canine urine sediment according to the LC-MS/MS analysis. The obtained results revealed the presence of the model peptide in 40.9% of dogs with MMVD (active glomerular injury secondary to heart disease = cardiorenal syndrome-CRS) and 33.3% dogs with chronic kidney disease. The potential applicability of the developed methodology in the analysis of podocin in canine urine sediments was confirmed.


Assuntos
Síndrome Cardiorrenal/veterinária , Doenças do Cão/diagnóstico , Peptídeos e Proteínas de Sinalização Intracelular/química , Proteínas de Membrana/química , Peptídeos/urina , Insuficiência Renal Crônica/veterinária , Animais , Biomarcadores/urina , Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/urina , Cromatografia Líquida , Doenças do Cão/urina , Cães , Feminino , Peptídeos e Proteínas de Sinalização Intracelular/urina , Masculino , Proteínas de Membrana/urina , Podócitos/citologia , Podócitos/metabolismo , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/urina , Sensibilidade e Especificidade , Espectrometria de Massas em Tandem
19.
Kidney Blood Press Res ; 44(4): 727-742, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31387100

RESUMO

BACKGROUND: Studies have demonstrated that cholesterol variability is an independent predictor of cerebrovascular and cardiovascular events. OBJECTIVE: This study aimed to investigate the association of visit-to-visit variability in total cholesterol (TC) with kidney decline in a Chinese community-based population. METHODS: We assessed intraindividual variability in TC among 6,465 hypertensive participants and correlated the results with endpoints. TC variability was measured using standard deviation (SD), average successive variability (ASV), coefficient of variation (CV), and variability independent of the mean (VIM). The endpoint of this study was progression of renal function decline defined as a decrease in estimated glomerular filtration rate (eGFR) ≥30% and to a level <60 mL/min/1.73 m2 during follow-up if the baseline eGFR was ≥60 mL/min/1.73 m2, or a decrease in eGFR ≥50% during follow up if the baseline eGFR was <60 mL/min/1.73 m2. RESULTS: After a median follow-up of 27 months, 13.5% (n = 877) of the participants experienced progression of renal function decline. In the multivariable-adjusted Cox model, each 1-SD increase in TC variability (by SD) increased the risk of renal function decline by 11% (HR = 1.11; 95% CI 1.034-1.197; p = 0.004); this was independent of the baseline eGFR, mean follow-up TC levels, and the lipid-lowering therapy. Similar results were found for the 3 other measures of variability, i.e., ASV, CV, and VIM. CONCLUSION: In subjects with hypertension, visit-to-visit variability in TC is an independent predictor of renal function decline.


Assuntos
Variação Biológica Individual , Colesterol/sangue , Progressão da Doença , Hipertensão , Insuficiência Renal Crônica/diagnóstico , Idoso , Grupo com Ancestrais do Continente Asiático , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Saúde Pública , Insuficiência Renal Crônica/fisiopatologia , Reprodutibilidade dos Testes
20.
BMC Res Notes ; 12(1): 466, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366401

RESUMO

OBJECTIVE: HIV positive individuals infected with viral hepatitis B (HBV) or C (HCV) are at an increased risk of progression to kidney and liver failures. Therefore, prior to initiation of antiretroviral therapy, early diagnosis and initiation of appropriate treatment protocols are imperative for co-infected individuals. This study evaluated the prevalence of HBV and HCV, and extent of liver and renal dysfunction among 90 newly diagnosed HIV patients attending the Cape Coast Teaching Hospital HIV clinic. RESULTS: Levels of alanine aminotransferase, aspartate-platelet ratio index and estimated glomerular filtration rate were used respectively to diagnose hepatotoxicity, liver fibrosis and chronic kidney disease (CKD). Association analyses were evaluated by Pearson's Chi-square test or Fisher's exact test and considered significant at p < 0.05. Using rapid diagnostic tests, 75.6% (n = 68) had HIV1 mono-infection, 24.4% (n = 22) had HIV1/HBV co-infection while 0.0% (n = 0) had HIV1/HCV co-infection. The prevalence of hepatotoxicity, liver fibrosis, and CKD were 7.8% (n = 7), 2.2% (n = 2), and 15.5% (n = 14) respectively. Similar proportions of HIV1/HBV and HIV1 were diagnosed with liver fibrosis (p = 0.431). In relation to hepatotoxicity Grade, a high proportion of HIV1/HBV were diagnosed with Grade 2 (p = 0.042). Also, severely reduced kidney function (CKD stage 4) was observed in only HIV1/HBV (n = 2, 9.1%, p = 0.053).


Assuntos
Infecções por HIV/fisiopatologia , Hepatite B/fisiopatologia , Hepatite C/fisiopatologia , Rim/fisiopatologia , Cirrose Hepática/fisiopatologia , Fígado/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Adulto , Alanina Transaminase/sangue , Ácido Aspártico/sangue , Plaquetas/patologia , Coinfecção , Estudos Transversais , Feminino , Gana/epidemiologia , Taxa de Filtração Glomerular , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/virologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Rim/metabolismo , Rim/virologia , Fígado/metabolismo , Fígado/virologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Cirrose Hepática/virologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/virologia
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