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1.
Yakugaku Zasshi ; 140(1): 81-90, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31902889

RESUMO

We previously reported the association of the estimated glomerular filtration rate (eGFRcreat) calculated from the serum creatinine level (S-Cr) measured using the Jaffe method with the GFR (eGFRcys) estimated from the serum cystatin C level (CysC). However, few studies have compared the eGFRcreat using the enzymatic method with the eGFRcys. It is unclear whether there are differences in the results of renal function assessment. The purpose of this study was to compare the eGFRcreat calculated from the S-Cr with the eGFRcys calculated from the CysC in patients in whom the S-Cr and CysC were simultaneously measured using the enzymatic method, examine the correlations of respective parameters, and clarify physiological factors involved in differences among the parameters. The subjects were 1334 patients treated in 5 institutions. The mean values and correlation coefficient were statistically analyzed using Student's t-test and Pearson's test, respectively. Influential factors between formulae were analyzed using multiple regression analysis. The mean eGFRcreat was 67.0 mL/min/1.73 m2, being significantly higher than the mean eGFRcys (63.2). Multiple regression analysis showed that factors influencing differences in the S-Cr and CysC included the sex, age, serum albumin, and blood urea nitrogen BUN/S-Cr. Furthermore, factors involved in the overestimation of the eGFRcreat in comparison with the eGFRcys included the serum albumin and BUN/S-Cr. The differences between the eGFRcreat calculated from the S-Cr and eGFRcys were less marked than when adopting the Jaffe method in our previous study. However, the eGFRcreat were higher than the eGFRcys in patients with malnutrition or dehydration.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Ensaios Enzimáticos/métodos , Testes de Função Renal/métodos , Insuficiência Renal Crônica/diagnóstico , Biomarcadores/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Taxa de Depuração Metabólica
2.
Medicine (Baltimore) ; 98(48): e18178, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770269

RESUMO

RATIONALE: Occasionally, tubulointerstitial lesions can be found in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, significantly isolated tubulointerstitial nephritis (TIN) with germinal centers is rare. PATIENT CONCERNS: A 17-year-old Chinese Han patient showed rapidly progressive glomerulonephritis, anuria, and serum creatinine of 19.4 mg/dL. DIAGNOSIS: He had positive ANCA targeting myeloperoxidase (55.0 RU/mL). The renal biopsy showed crescent formation in 100% of glomeruli. Of special note, the glomerular crescents were surrounded by granulomatous inflammation, extensive tubular destruction or disappearance, and massive interstitial infiltration. A diagnosis of AAV was thus made with the involved organ restricted to the kidney. INTERVENTIONS: The patient underwent 7 rounds of plasmapheresis, 3 pulses of methylprednisolone therapy (500 mg per pulse), and oral prednisolone (50 mg/d). Rituximab (500 mg) was used after the plasma exchange treatment. OUTCOMES: ANCA was negative, while anti-modified C-reactive protein (anti-mCRP) antibodies remained positive. The patient was dependent on hemodialysis. We found anti-mCRP antibody in the serum of the patient, with the major epitope on amino acids 35 to 47 of mCRP. LESSONS: We proposed that the anti-mCRP antibody might play an important role in this case of acute TIN in AAV.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Proteína C-Reativa/imunologia , Glucocorticoides/administração & dosagem , Nefrite Intersticial , Troca Plasmática/métodos , Plasmaferese/métodos , Rituximab/administração & dosagem , Adolescente , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Anticorpos Anticitoplasma de Neutrófilos/sangue , Progressão da Doença , Centro Germinativo/patologia , Humanos , Fatores Imunológicos/administração & dosagem , Testes de Função Renal/métodos , Glomérulos Renais/patologia , Glomérulos Renais/fisiopatologia , Masculino , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/imunologia , Nefrite Intersticial/fisiopatologia , Nefrite Intersticial/terapia , Resultado do Tratamento
3.
BMC Res Notes ; 12(1): 655, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604451

RESUMO

OBJECTIVES: This study validates two popular predictive equations of renal function firstly, Modifications of Diet in Renal Disease and secondly, Chronic Kidney Disease Epidemiology Collaboration equations for Sri Lankan cohort. We used data of the patients referred to Renal Research lab of University of Colombo for creatinine clearance measurement. RESULTS: Predictive performances varied with the gender. Creatinine clearance and predicted renal functions were compared. Both fared unsatisfactorily with R2 ranging from 0.632 to 0.652, and overestimated renal function by 6-15%. The proportion chronic kidney disease staging 1 and 2 returned by Chronic Kidney Disease Epidemiology Collaboration equation showed significant difference, in females. Modifications of Diet in Renal Disease equation significantly under-estimated advanced chronic kidney disease in females. Chronic Kidney Disease Epidemiology Collaboration equation had better accuracy. The study sample had more females, Asian and lower body size and better renal functions than historic cohorts. Thai and Pakistani studies show both equations and their Asian adaptations fare poorly. Chronic kidney disease stages differ significantly with the equation used. Predictive equations have fared unsatisfactorily by overestimating renal functions. We recommend further studies using gold standards of measuring renal function.


Assuntos
Creatinina/farmacocinética , Nefropatias/fisiopatologia , Testes de Função Renal/métodos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Algoritmos , Estudos de Coortes , Dieta , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/metabolismo , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Modelos Teóricos , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/metabolismo , Sri Lanka
4.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31510053

RESUMO

Standard methods for detecting and monitoring of IgA nephropathy (IgAN) have conventionally required kidney biopsies or suffer from poor sensitivity and specificity. The Kidney Injury Test (KIT) Assay of urinary biomarkers has previously been shown to distinguish between various kidney pathologies, including chronic kidney disease, nephrolithiasis, and transplant rejection. This validation study uses the KIT Assay to investigate the clinical utility of the non-invasive detection of IgAN and predicting the progression of renal damage over time. The study design benefits from longitudinally collected urine samples from an investigator-initiated, multicenter, prospective study, evaluating the efficacy of corticosteroids versus Rituximab for preventing progressive IgAN. A total of 131 urine samples were processed for this study; 64 urine samples were collected from 34 IgAN patients, and urine samples from 64 demographically matched healthy controls were also collected; multiple urinary biomarkers consisting of cell-free DNA, methylated cell-free DNA, DMAIMO, MAMIMO, total protein, clusterin, creatinine, and CXCL10 were measured by the microwell-based KIT Assay. An IgA risk score (KIT-IgA) was significantly higher in IgAN patients as compared to healthy control (87.76 vs. 14.03, p < 0.0001) and performed better than proteinuria in discriminating between the two groups. The KIT Assay biomarkers, measured on a spot random urine sample at study entry could distinguish patients likely to have progressive renal dysfunction a year later. These data support the pursuit of larger prospective studies to evaluate the predictive performance of the KIT-IgA score in both screening for non-invasive diagnosis of IgAN, and for predicting risk of progressive renal disease from IgA and utilizing the KIT score for potentially evaluating the efficacy of IgAN-targeted therapies.


Assuntos
Biomarcadores/urina , Glomerulonefrite por IGA/urina , Monitorização Fisiológica/métodos , Corticosteroides/uso terapêutico , Adulto , Creatinina/urina , Progressão da Doença , Feminino , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/tratamento farmacológico , Humanos , Imunoglobulina A/urina , Fatores Imunológicos/uso terapêutico , Rim/patologia , Rim/fisiopatologia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteinúria/urina , Rituximab/uso terapêutico , Sensibilidade e Especificidade , Adulto Jovem
5.
Biomed Pharmacother ; 117: 109154, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31387184

RESUMO

Gentamicin, an aminoglycoside drug, used for the treatment of Gram-negative bacterial infections. Despite its potency against bacterial infections, its clinical use is limited owing to nephrotoxicity effect. However, the study investigated the nephroprotective effect of fatty acids from ethanolic extract of Moringa oleifera seeds (EEMOS) against gentamicin-induced kidney injury in rats. Forty-five male Wistar rats, 100-160 g, were divided into 5 groups as follows: Group 1 (control), 5 rats, received 0.2 ml/100 g/day of propylene glycol orally for 28 days. Group 2, 10 rats, received 100 mg/kg/day (i.p) of gentamicin (GENT) for 8 days. Group 3-5, 10 rats each, treated with EEMOS orally for 28 days at graded doses of 100, 200 and 400 mg/kg respectively after GENT treatment. Twenty four after treatment, five rats from each group were sacrificed. The remaining 5 rats were sacrificed after 2 weeks recovery period from the drugs. The result showed that GENT elicited polyuria, elevated plasma creatinine, urea, and lower plasma electrolytes and creatinine clearance levels. Measurements of 24 h urinary output demonstrated marked decrease in creatinine and potassium levels in the GENT-treated group, whereas sodium level remain unchanged. Also, GENT caused significant decrease in superoxide dismutase and an increase in malondialdehyde levels in the kidney of the rats. Histopathological examination revealed evidence of necrosis of the kidney. Treatment with EEMOS significantly ameliorated the alterations caused by GENT in the plasma, urine and kidney homogenate of the rats. Hence, the mono- and poly-unsaturated fatty acids present in EEMOS were responsible for its renoprotective ability.


Assuntos
Ácidos Graxos/farmacologia , Rim/efeitos dos fármacos , Moringa oleifera/química , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/farmacologia , Insuficiência Renal/tratamento farmacológico , Animais , Antioxidantes/metabolismo , Creatinina/metabolismo , Etanol/química , Gentamicinas/farmacologia , Rim/metabolismo , Testes de Função Renal/métodos , Masculino , Malondialdeído/metabolismo , Ratos , Ratos Wistar , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/metabolismo , Sementes/química , Superóxido Dismutase/metabolismo
6.
Ann Biol Clin (Paris) ; 77(4): 371-374, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418697

RESUMO

Direct measurement methods of glomerular filtration rate (GFR) are considered as the gold standard to assess kidney function. Following the withdrawal of the Proinuline Serb® specialty by the French National Health Surveillance Agency, iohexol remains the most suitable marker to replace inulin as the marker for GFR in France. The assay is performed by high performance liquid chromatography (HPLC) coupled with ultraviolet (UV) detection or by mass spectrometry. Plasma clearance measurement is the protocol of choice: single-sample protocols dominate, but multiple-sample protocols may be more accurate in specific situations to improve accuracy. In some cases, urinary clearance protocols may be proposed. National and international recommendations suggest using a GFR measurement as a confirmatory test in cases where the creatinine-based estimated GFR is inappropriate, ie clinical situations characterized by a significant alteration of muscle mass or volume distribution. The indications retained by the working group were graded according to the level of recommendations. The essential indications are the evaluation of living kidney donor, the monitoring of kidney allograft function at one year post-transplantation, drugs with narrow therapeutic range (anticoagulant, chemotherapy) in patients with inadequate estimation of GFR by creatinine and clinical research.


Assuntos
Taxa de Filtração Glomerular , Testes de Função Renal , Biomarcadores/análise , Biomarcadores/metabolismo , Creatinina/sangue , França , Humanos , Internacionalidade , Iohexol/análise , Iohexol/metabolismo , Nefropatias/sangue , Nefropatias/diagnóstico , Testes de Função Renal/métodos , Testes de Função Renal/normas , Padrões de Referência
7.
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
8.
Ann Biol Clin (Paris) ; 77(4): 391-396, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418700

RESUMO

The SFBC working group aimed to deal with biological tests outside the French nomenclature that may be useful for the follow-up of dialysis patients. Our discussion was divided into 3 parts: 1) evaluation of peritoneal membrane characteristics; 2) monitoring of renal replacement therapy using regional citrate anticoagulation; 3) estimation of residual renal function (RRF). International recommendations underline the importance of assessing peritoneal membrane characteristics for peritoneal dialysis prescription. This peritoneal equilibrium test requires the measurement in dialysate of the following parameters: glucose, urea, creatinine and sodium. As part of the monitoring of continuous renal replacement therapy using regional citrate anticoagulation, the determination of ionized calcium assay is essential according to national and international guidelines to ensure a balance between effective anticoagulation and appropriate calcium levels. Finally, the RRF plays a key role in the dialysis adequacy and patient survival. European and international recommendations highlight the potential interest of RRF in peritoneal dialysis and hemodialysis. The RRF corresponds to the mean of urinary urea and creatinine clearance, assessed from a urine collection with measurement of urinary urea.


Assuntos
Testes de Função Renal/métodos , Rim/fisiopatologia , Monitorização Fisiológica/métodos , Peritônio/fisiologia , Diálise Renal/métodos , Anticoagulantes/química , Anticoagulantes/metabolismo , Cálcio/metabolismo , Ácido Cítrico/química , Ácido Cítrico/metabolismo , Humanos , Rim/metabolismo , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Peritoneal/métodos
9.
Transplant Proc ; 51(7): 2312-2317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400978

RESUMO

PURPOSE: The aim of this study is to determine the correlation between the predonation computed tomography (CT)-based calculated kidney volume and post-transplant renal function in recipients of renal transplants and to compare two different CT techniques. MATERIAL AND METHODS: The study group is comprised of 55 paired living kidney donor-recipients transplants. The total parenchymal renal volumes were calculated by using two CT-based techniques (3-dimensional renal volume [3DRV] and voxel-based volume calculation). Post-transplant creatinine and estimated glomerular filtration rate (eGFR) levels for the recipients at hospital discharge and sixth month were obtained. We tested the association with eGFR and creatinine by adjusting the renal volume to body weight and body mass index. For the creatinine levels above 1.5 mg/dL at discharge, a threshold value for renal volume-to-weight ratio on receiver operating characteristic curve (ROC) analysis and odds ratio (OR) were calculated. RESULTS: The renal volumes adjusted to weight were found to be moderately correlated with eGFR and creatinine levels at discharge (r = 0.51 and r = -0.54 for voxel-based calculation; r = 0.52 and r = -0.52 for 3DRV calculation, P < .001, respectively) and at sixth month (r = 0.55 and r = -0.58 for voxel-based calculation; r = 0.51 and r = -0.54 for 3DRV calculation, P < .001 respectively). A threshold value of 1.84 mL/kg was calculated for parenchymal volume-to-recipient weight ratio on ROC analysis (AUC±SE, 0.760 ± 0.078, P = .008). The likelihood of creatinine elevation above 1.5 mg/dL was found to be nine times greater for smaller renal volume-to-recipient weight ratios (OR = 9.6; 95% CI, 1.8-50.6) CONCLUSIONS: Predonation renal volume adjusted to recipient weight may estimate the renal function at discharge and 6 months after transplantation.


Assuntos
Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Transplante de Rim/métodos , Rim/patologia , Transplantes/patologia , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Creatinina/análise , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Testes de Função Renal/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Tamanho do Órgão , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Transplantes/diagnóstico por imagem , Transplantes/fisiopatologia , Resultado do Tratamento
10.
Nucl Med Commun ; 40(10): 1029-1035, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31469806

RESUMO

BACKGROUND: Measurement of glomerular filtration rate from a single blood sample using filtration markers may be based on empirical or model-based formulae. The former do not require a whole body metric but are sample time-inflexible. The latter include time as a continuous variable but require a whole body metric to estimate extracellular fluid volume. This study describes a new empirical method that is time-flexible and requires no whole body metric. METHODS: Data comprise 982 slope-intercept glomerular filtration rate measurements from a single institution in which the correlation coefficient of the three-sample fit was ≥0.999. In 582 measurements, samples were taken at 118-122, 144-148, 178-182, 202-206 or 238-242 minutes. Within each of these five sample time groups, slope, k(t), of the regression of apparent volume of distribution (Vt) against slope-intercept glomerular filtration rate was recorded following exclusion of outliers. The five sampling times correlated closely and exponentially with k(t) (=5.4.e), allowing calculation of k(t) for any sampling time. In a further 341 measurements, glomerular filtration rate from a single blood sample was calculated as [k(t).V(t)] and compared with slope-intercept glomerular filtration rate. Sample time for glomerular filtration rate from a single blood sample is critical, so the most appropriately timed sample was chosen according to slope-intercept glomerular filtration rate/1.73 m. RESULTS: The current method compared favourably with three previously published model-based methods (Fleming et al., Jacobsson and Gref and Karp), showing better precision, and unlike the other three, no correlation between difference and average on Bland-Altman analysis. CONCLUSION: This completely time-flexible, empirically-derived approach to glomerular filtration rate from a single blood sample requires no whole body metric, is simple, equally applicable to children and adults and superior to three model-based methods.


Assuntos
Sangue/metabolismo , Taxa de Filtração Glomerular , Testes de Função Renal/métodos , Humanos , Fatores de Tempo
11.
BMC Pregnancy Childbirth ; 19(1): 259, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331287

RESUMO

BACKGROUND: Acute Fatty Liver of Pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. CASE PRESENTATION: We report a case of AM, an 18 year patient, in her first pregnancy at 35 weeks gestation who presented with nausea, vomiting and jaundice. She had a vaginal delivery following spontaneous preterm labour. A clinical diagnosis of acute fatty liver of pregnancy was made on the 3rd day post-delivery. The post-delivery course was complicated by a deterioration of clinical symptoms with worsening hepatorenal function and development of encephalopathy. The patient died 3 days after admission and the diagnosis was confirmed on post-mortem and histology. CONCLUSION: Delay in the diagnosis is associated with morbid complications with high mortality and this case highlights the importance of a high index of suspicion of the condition in women presenting with jaundice in pregnancy.


Assuntos
Fígado Gorduroso , Icterícia , Complicações na Gravidez , Adolescente , Deterioração Clínica , Diagnóstico Tardio , Parto Obstétrico/métodos , Diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/fisiopatologia , Fígado Gorduroso/terapia , Feminino , Humanos , Icterícia/diagnóstico , Icterícia/etiologia , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Paridade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Terceiro Trimestre da Gravidez
12.
Clin Chim Acta ; 497: 13-19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271741

RESUMO

BACKGROUND: As iodine-based contrast can cause deterioration of renal function in patients with impaired kidney function, guidelines advise to measure creatinine and calculate estimated glomerular filtration (eGFR) prior to administration. Point-of-care (POC) devices seem an attractive alternative to central laboratory testing but uncertainty regarding analytical and clinical comparability remains. METHODS: This study compared three POC devices, i-STAT (Abbott), StatSensor (Nova) and epoc (Siemens) with a central laboratory method (enzymatic creatinine, Siemens Vista 1500 platform). 120 patients were included and underwent simultaneous finger prick capillary blood analysis on the StatSensor and heparine whole blood analysis on StatSensor, i-STAT and epoc. RESULTS: All POC devices generated results which showed considerable variability around the creatinine value of the reference standard, with StatSensor having the widest (-1,12-1,11 mg/dL) and epoc the tightest (-0,49-0,49 mg/dL) 95% limits of agreement. I-STAT showed the highest clinical concordance with the reference standard (Kappa: 0,94) and had the smallest average analytical error (6%) for creatinine and eGFR compared to the reference standard, meeting the predefined criteria of 8,87% and 10%, respectively. Epoc only met criteria for eGFR. StatSensor did not meet any of the criteria. CONCLUSIONS: I-STAT and epoc were, analytically and clinically, the most performant POC devices included in this study but showed to be less user-friendly. StatSensor did not meet any of the error criteria, neither for creatinine nor for eGFR measurements, and gave more clinical major classification errors. However, it proved to be more user-friendly compared to the other POC devices.


Assuntos
Técnicas de Laboratório Clínico , Meios de Contraste , Creatinina/sangue , Testes de Função Renal/métodos , Imagem por Ressonância Magnética , Sistemas Automatizados de Assistência Junto ao Leito , Insuficiência Renal Crônica/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Receptores ErbB/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito/normas , Insuficiência Renal Crônica/diagnóstico , Adulto Jovem
13.
Eur J Radiol ; 117: 209-215, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31221527

RESUMO

OBJECTIVES: To evaluate the performance of dynamic contrast-enhanced MRI measurement of glomerular filtration rate (GFR) compared with the reference standard technique of urinary clearance of 51Cr-EDTA. PATIENTS AND METHODS: All kidney transplant recipients (KTRs) with an indication for non-urgent contrast-enhanced MRI at our institution were prospectively included between 2008 and 2012. Renographies were acquired by low-dose dynamic contrast-enhanced MRI (DCE-MRI) then fitted with a two-compartment pharmacokinetic model. MR-GFR was compared with reference isotopic measurements using Bland-Altman diagrams, intraclass correlation coefficient (ICC) and concordance rates. RESULTS: Forty-two KTRs (mean age 51.5 years, 26-74) were analyzed. Mean estimated GFR was 48.5 ± 27 mL/min/1.73m2 (24-178 mL/min). The mean bias was +13.2 mL/min (6.4-20.0, +36.9%) ranging from -31.0 mL/min (-41.7%) to +101.4 mL/min (+89.2%) with a large variability (standard-deviation: 22.3 mL/min; limits of agreement: [-30.6 (-43.3--18.9); +57.0 (45.3-68.7)]). The ICC was 0.32 (0.02-0.56) and the concordance rate was 28.6% (14.9-42.2). CONCLUSIONS: The large variability of MR-GFR compared with the reference technique precludes its use in KTRs, whose anatomical peculiarities make standardization of arterial input function (AIF) difficult.


Assuntos
Radioisótopos de Cromo/farmacocinética , Ácido Edético/farmacocinética , Transplante de Rim , Imagem por Ressonância Magnética , Transplantados , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
J Clin Pharm Ther ; 44(5): 750-759, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31228353

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Although patients may have received vancomycin therapy with therapeutic drug monitoring (TDM), those treated with high-strength and long-term vancomycin therapy might have unstable and time-varying renal function. The methods used to estimate renal function should not be considered interchangeable with pharmacokinetic (PK) modeling and model-based estimation of vancomycin pharmacokinetics. While Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for renal function estimation has been widely integrated into clinical practice, a population PK model including CKD-EPI has not been established. The study was aimed at developing a new population PK model for optimal vancomycin prediction in patients with time-varying and variable renal function to evaluate the interchangeability of estimation methods. METHODS: The most suitable population PK model was explored and evaluated using non-linear mixed-effect modelling for the best fit of vancomycin concentrations from patients who needed to maintain high trough vancomycin concentrations of >10 mg/L or >15 mg/L. Renal function was estimated using the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and CKD-EPI equations. NONMEM 7.4 was used to develop the population PK model. RESULTS: A total of 328 vancomycin concentrations in 99 patients were used to develop the population PK model. Vancomycin pharmacokinetics was best described by a two-compartment model. The CKD-EPI equation for vancomycin clearance was included in the final model among the estimation methods of renal function. A new covariate model, including extended covariate parameters that explain changes in renal function from the population-predicted value and individual dosing time, provided the best explanation for vancomycin pharmacokinetics among the various models tested. WHAT IS NEW AND CONCLUSION: A new extended covariate model for vancomycin using the CKD-EPI method may afford suitable dose adjustment for high-strength and long-term vancomycin therapy that results in unstable renal function.


Assuntos
Taxa de Filtração Glomerular/efeitos dos fármacos , Insuficiência Renal Crônica/induzido quimicamente , Vancomicina/efeitos adversos , Vancomicina/farmacocinética , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Vancomicina/administração & dosagem
15.
Rev Invest Clin ; 71(3): 195-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31184334

RESUMO

Background and Aims: Glomerular filtration rate (GFR) measurement in patients with liver cirrhosis (LC) is the ideal method for adequate evaluation of kidney function. However, it is invasive, costly, and not widely accessible. Moreover, GFR estimation in patients with cirrhosis has been inaccurate. The aim of the present study was to evaluate and validate the recently described Royal Free Hospital (RFH) formula in a Hispanic cohort of patients with LC and compare it with other formulas, including the CKD-EPI cystatin C equation. Methods: GFR was measured through the renal clearance of Tc-99m DTPA; it was cross-sectionally evaluated and compared with GFRs that were estimated utilizing the following formulas: RFH, Cockcroft-Gault, 6-variable Modification of Diet in Renal Disease-6, CKD-EPI cystatin C, CKD-EPI Creatinine, and CKD-EPI Cystatin C-Creatinine. Results: We included 76 patients (53% women). The mean measured GFR in the entire cohort was 64 ml/min/1.73m2; 54% of the patients had a GFR < 60 ml/min/1.73 m2 at the time of evaluation. The RFH formula and the CKD-EPI cystatin C formula showed the best performance, with a p30 of 62% and 59%, respectively. All formulas performed poorly when GFR was < 60 ml/min/1.73 m2. Conclusions: The RFH formula showed a better performance than the other formulas based on serum creatinine in a Hispanic population with LC. There was no difference in performance between the RFH formula and the CKD-EPI cystatin C formula.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Nefropatias/diagnóstico , Testes de Função Renal/métodos , Cirrose Hepática/fisiopatologia , Estudos de Coortes , Creatinina/sangue , Estudos Transversais , Cistatina C/metabolismo , Feminino , Humanos , Nefropatias/fisiopatologia , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Phytother Res ; 33(8): 2023-2033, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31215078

RESUMO

Unilateral ureteral obstruction (UUO) causes severe renal tubulointerstitial fibrosis. Because of many pharmacologic properties of thymoquinone (TQ), in this study, the effects of TQ against kidney fibrosis and dysfunction were investigated in rats with UUO. Forty male Wistar rats were divided into five groups: Sham operated, UUO, and the animals with UUO treated with losartan, captopril, or TQ. Collagen IV and transforming growth factor (TGF)-ß1 expressions, interstitial fibrosis, histological changes, and kidney function were assessed. UUO markedly increased renal expression of TGF-ß1 and collagen I and induced interstitial fibrosis (p < .001). Losartan, captopril, or TQ significantly downregulated the expression of these fibrotic markers and interstitial fibrosis (p < .01-p < .001). In UUO group, serum levels of urea and creatinine and protein excretion rate significantly increased, but glomerular filtration rate (GFR) and urine osmolarity showed a significant decrease (p < .001-p < .05). Administration of captopril and TQ caused no significant change in serum urea and protein excretion rate. Unlike losartan and captopril, TQ caused no significant alteration in GFR compared with Day 1. Losartan caused significant increases in serum urea and creatinine but significant decrease in urine osmolarity. TQ could be regarded as a potent therapeutic agent for treatment of UUO-induced kidney fibrosis and dysfunction.


Assuntos
Benzoquinonas/uso terapêutico , Fibrose/tratamento farmacológico , Nefropatias/tratamento farmacológico , Túbulos Renais/efeitos dos fármacos , Rim/efeitos dos fármacos , Obstrução Ureteral/tratamento farmacológico , Animais , Benzoquinonas/farmacologia , Rim/patologia , Nefropatias/patologia , Testes de Função Renal/métodos , Masculino , Ratos , Ratos Wistar
17.
Clin Exp Nephrol ; 23(10): 1196-1201, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31172351

RESUMO

BACKGROUND: Selectivity index (SI) of proteinuria, calculated using the clearance ratio of immunoglobulin G to transferrin, predicts the response to glucocorticoids in patients with nephrotic syndrome. However, there is disagreement regarding the suitability of SI. Therefore, alternate indices should be considered. This study investigated whether or not selectivity index protein fraction (SIPF) was inferior to SI for the prediction of the response to glucocorticoids. METHODS: Forty-nine patients with nephrotic syndrome were evaluated. On the basis of molecular weight and protein fraction, as an inexpensive substitute for SI, the clearance ratio of the albumin to γ fractions measured in serum and urine protein fractions was defined as SIPF. The quality of SIPF was examined. Moreover, the best cutoff value of SIPF was determined; and SIPF distribution, according to histopathological diagnosis by renal biopsy, was examined. RESULTS: SIPF was strongly correlated with SI (r = 0.79, P < 0.001). The area under the receiver operating characteristic (ROC) curve of SIPF and SI was not significantly different (P = 0.18). The best cutoff value of SIPF was 0.45. In the group with SIPF > 0.45, only two patients with minimal change disease (MCD) achieved complete remission. In the group with SIPF ≤ 0.45, all patients with MCD achieved complete remission, although eight patients with other histopathological diagnoses did not achieve complete remission. CONCLUSIONS: Analysis of protein fractions as a substitute for SI may be useful for predicting response to glucocorticoids in patients with nephrotic syndrome.


Assuntos
Testes de Função Renal/métodos , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/tratamento farmacológico , Proteinúria/diagnóstico , Adulto , Idoso , Albuminúria/diagnóstico , Biópsia , Estudos de Coortes , Feminino , Glucocorticoides/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Rim/patologia , Masculino , Pessoa de Meia-Idade , Peso Molecular , Síndrome Nefrótica/patologia , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Resultado do Tratamento
18.
Biol Pharm Bull ; 42(8): 1350-1357, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31167988

RESUMO

Creatinine (Cr) levels are strongly affected by muscle mass, and the estimated glomerular filtration rate (eGFR), a measure based on serum creatinine (SCr), is often overestimated in patients with sarcopenia. To evaluate the coefficient of determination (R2) between eGFR and the actual measured value, we performed a linear regression analysis of a modified GFR (mGFR: measured Cr clearance × 0.715) and various renal function estimates adjusted for muscle mass in 19 patients with sarcopenia. The eGFR values based on SCr (eGFRcr) were higher than those based on mGFR, although a high R2 (0.704; p < 0.001) was found between these values. There was no deviation between eGFR based on serum cystatin C (eGFRcys) and mGFR, although the R2 value 0.691 was equivalent to that of eGFRcr. In the equation used to calculate eGFRcr not adjusted for body surface area (mL/min), muscle mass parameters obtained from bioelectrical impedance analysis were used instead of actual body weight to recalculate the eGFRcr. The R2 between this eGFRcr and mGFR did not improve, although there was less deviation. However, assuming that all patients were female by using female coefficients for all patients, the R2 between eGFRcr-fcc (eGFRcr with female coefficient correction) and mGFR improved and was the highest (0.808) on substitution of appendicular skeletal muscle mass. The correlation between eGFRcr-fcc and mGFR improved over eGFRcys when muscle mass was substituted for body weight in the equation used to estimate eGFR in patients with sarcopenia and sex differences were removed.


Assuntos
Testes de Função Renal/métodos , Músculo Esquelético/metabolismo , Sarcopenia/metabolismo , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Peso Corporal , Creatinina/sangue , Cistatina C/sangue , Feminino , Identidade de Gênero , Taxa de Filtração Glomerular , Humanos , Japão , Masculino , Músculos , Estudos Prospectivos
19.
Diabetes Res Clin Pract ; 153: 176-183, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31195024

RESUMO

AIM: To evaluate the effect of Ramadan fasting on kidney functions in patients with type 2 DM. METHODS: We recruited 90 subjects with type 2 DM intending to fast Ramadan; classified into 30 with albuminuria and renal impairment (group I), 30 with albuminuria and normal kidney functions (group II) and 30 without albuminuria and normal kidney functions (group III). Two weeks before and after Ramadan, fasting plasma glucose, 2 h plasma glucose, hemoglobin A1c, fructosamine, serum creatinine, BUN, eGFR and albumin/ creatinine ratio were measured. RESULTS: On comparing data before and after Ramadan, significant reduction in HbA1c was found in all groups. As regards kidney function parameters, no significant difference was found in group I but a significant decline in these parameters was found in groups II and III; serum creatinine, eGFR, urinary albumin/ creatinine ratio (p <0.001). Only Group I showed significant hypoglycemic events and need for dose reduction. CONCLUSION: Ramadan fasting improved glycemic control in patients with type 2 DM with no decline in kidney functions in renally impaired group, only a decline in albuminuric and healthy groups within the normal range. Patients should be adviced regarding adequate hydration and dietary modification during Pre-Ramadan health care education.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Jejum/efeitos adversos , Testes de Função Renal/métodos , Feminino , Hemoglobina A Glicada/análise , Humanos , Islamismo , Masculino , Pessoa de Meia-Idade
20.
Medicine (Baltimore) ; 98(21): e15465, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124929

RESUMO

This study aimed to explore the diagnostic performance of the ratio of renal resistive index (RRI) to semiquantitative power Doppler ultrasound (PDU) score in predicting acute kidney injury (AKI) 3 in critically ill patients.This study was a prospective, observational study that included 101 critically ill patients. RRI and semiquantitative PDU score were measured within 6 hours following admission to the intensive care unit (ICU). The ratio of RRI to PDU (RRI/PDU) was calculated as follows: RRI / PDU. If PDU score was 0, the RRI/PDU was 1. Meanwhile, AKI was defined according to the Kidney Disease Improving Global Outcomes criteria.Median RRI/PDU was 0.234 (0.190, 0.335) in patients with AKI 0-2 and 0.636 (0.411, 0.738) in patients with AKI 3 (P < .001). As assessed by the area under the receiver operator characteristic curves (AUC), RRI/PDU performed best in diagnosing AKI 3 [AUC = 0.935 (95% CI: 0.868-0.974)]. Optimal cuto for RRI/PDU was > 0.37, and the sensitivity and specificity were 90.5% and 90.0%, respectively. In 93 patients, except for 8 patients with a PDU score of 0, the AUC of RRI/PDU [0.938 (95% CI: 0.868-0.977)] was superior to the PDU score (0.905 [95% CI: 0.826-0.956], P = .133), RRI [0.782 (95% CI: 0.684-0.861), P = .016], serum creatinine [0.801 (95% CI: 0.705-0.877), P = .017], or 6 hours AKI stage (0.876 [95% CI: 0.791-0.935], P = .110) in predicting AKI 3 on D5.In our study, RRI, PDU score, RRI/PDU, and 6 hours AKI stage were useful in predicting AKI 3. Furthermore, RRI/PDU may be a better predictor of AKI 3.


Assuntos
Lesão Renal Aguda/diagnóstico , Testes de Função Renal/estatística & dados numéricos , Índice de Gravidade de Doença , Ultrassonografia Doppler/estatística & dados numéricos , Idoso , Área Sob a Curva , Creatinina/sangue , Feminino , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Resistência Vascular
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