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2.
Mayo Clin Proc ; 95(8): 1649-1659, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753139

RESUMO

OBJECTIVE: To characterize the use of cystatin C (cysC) across and within hospitals. PATIENTS AND METHODS: This 2-part study first evaluated access to cysC testing across 129 hospitals in the state of Minnesota, using a telephone-based survey. Second, granular data from a single center (Mayo Clinic) with on-site, rapid-turnaround testing (<1 day) and automated estimated glomerular filtration rate (eGFR) reporting was used to describe temporal patterns. The characteristics of hospitals that offered cysC testing and of patients who underwent rapid cysC testing at Mayo Clinic between January 1, 2011, and March 31, 2018, were described. Poisson regression analyzed temporal trends in cysC testing. RESULTS: Of the 114 hospitals (88%) that responded to the statewide survey, cysC was available in 91 (80%), but only 3 of 91 (3%) reported a turnaround time of <1 day. At Mayo Clinic, cysC use increased from 0.74 tests per 1000 patient-days in 2011 to 14 tests per 1000 patient-days in 2018 (P=.004). Of the 3774 patients with cysC tests, the mean first available eGFR was 46 mL/min per 1.73 m2 using cysC and 59 mL/min per 1.73 m2 using serum creatinine (P<.001). CysC testing was used across all intensities of care and was ordered by a variety of specialties. Nephrology was consulted in only 42% of cases. CONCLUSION: In the hospital, rapid-turnaround cysC testing is necessary for practical use but was not widely available in Minnesota. When available, a marked increase in cysC testing was observed over the study timeframe. Additional research is needed to determine optimal strategies for implementation of cysC within hospitals.


Assuntos
Cistatina C/sangue , Hospitais/estatística & dados numéricos , Nefropatias/diagnóstico , Testes de Função Renal/estatística & dados numéricos , Biomarcadores/sangue , Difusão de Inovações , Feminino , Humanos , Nefropatias/sangue , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Minnesota , Inquéritos e Questionários
3.
Clin Interv Aging ; 15: 733-742, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32546991

RESUMO

Purpose: Reduced kidney function has been associated with an increased risk for adverse outcomes. Accurate assessment of glomerular filtration rate (GFR) is key to diagnosis and management of kidney disfunction. Debate exists on the best GFR estimation equation for elderly people. This study aimed to compare the predictive validity and discriminative ability of four GFR equations in relation to 2-year and 6-year mortality in exceptional longevity (EL) (those over 95 years old with intact health) individuals and is an ideal model to address factors relating to life span and age-related diseases. Patients and Methods: This study used 6 years' data of 278 EL from the Rugao longevity cohort. Baseline GFR was estimated using four equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease Study (MDRD) equation, Berlin Initiative Study-1 (BIS) equation, and modified MDRD equation. Predictive validity was tested using Cox proportional hazards analysis. Overall improvement in reclassification based on estimated GFR (eGFR) was assessed applying net reclassification improvement (NRI). Results: Mean age of participants was 97±2 years with median follow-up of 2.6 years. Median (IQR) eGFR by CKD-EPI, MDRD, BIS, and modified MDRD equations were 73.9 (62.2-77.6), 82.3 (67.4-98.6), 56.4 (47.9-63.9), and 101.5 (83.1-121.6) mL/min per 1.73 m2, respectively. Higher eGFREPI was associated with lower mortality after multivariate adjustment (for continuous eGFREPI, HRtwo-year 1.018, 95% CI 1.002-1.033, P=0.023; HRsix-year 1.013, 95% CI 1.002-1.025, P=0.022), while eGFR from other equations did not show any associations with mortality. NRI for two-year mortality was 0.14 and approximately significant, which may favor the CKD-EPI when compared to BIS equation (P=0.052). Conclusion: The CKD-EPI equation showed more accurate estimation of kidney function in the elderly with respect to GFR distribution and predictability of mortality risk.


Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Longevidade/fisiologia , Insuficiência Renal/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Testes de Função Renal/métodos , Masculino , Mortalidade , Valor Preditivo dos Testes , Insuficiência Renal/epidemiologia , Reprodutibilidade dos Testes , Fatores de Risco
4.
Arch Med Res ; 51(6): 548-555, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32505416

RESUMO

BACKGROUND: Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy. AIMS OF THE STUDY: The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM. METHODS: Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson's correlation tests on SPSS. RESULTS: The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r = 0.171 (p = 0.101), BUN r = 0.244 (p = 0.007), creatinine r = 0.215 (p = 0.018), UACR r = 0.375 (p = <0.001) and GFR r = 0.215 (p = <0.019). CONCLUSION: The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its' role as an early and reliable biomarker of DM and its associated nephropathy.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Glicopeptídeos/efeitos adversos , Testes de Função Renal/métodos , Rim/patologia , Neurofisinas/metabolismo , Precursores de Proteínas/metabolismo , Vasopressinas/metabolismo , Adolescente , Adulto , Idoso , Feminino , Glicopeptídeos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
5.
Diabetes Res Clin Pract ; 165: 108272, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32561454

RESUMO

BACKGROUND: Several studies have indicated that high albuminuria is associated with renal function decline. However, the relationship between the urinary albumin-to-creatinine ratio (ACR) and risk of developing tubular injury remains unclear. Our aim was to investigate the association of ACR with the risk of developing tubular impairment in patients with type 2 diabetes. METHODS: This longitudinal observational study compared baseline with follow-up data in 183 patients with type 2 diabetes. ACR, urinary alpha-1-microglobulin-to-creatinine ratio (A1MCR) and estimated glomerular filtration rate (eGFR) were used to evaluate albuminuira, tubular injury and glomerular filtration function, respectively. RESULTS: Levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and A1MCR were significantly different at the two-year follow-up compared with baseline levels. Among patients both with baseline ACR above and below 30 mg/g, the percentage with A1MCR > 15 mg/g clearly increased after follow-up (P < 0.05). The risk of A1MCR rising from normal ranges to >15 mg/g over the follow-up increased with increasing baseline ACR values lower baseline eGFR. Among the patients with baseline ACR > 63.10 mg/g, all showed increased A1MCR values at follow-up compared with baseline. In the multivariate regression analysis, the patients with baseline ACR > 63.10 mg/g had a strong risk of A1MCR rising from normal to >15 mg/g (odds ratio (OR) = 11.12, P = 0.001) over the follow-up, while the males had a 2.89-fold risk of A1MCR increasing from normal to >15 mg/g compared with females. CONCLUSION: Baseline ACR level is related to increased risk of developing renal tubular injury; in particular, this association is much stronger in patients with type 2 diabetes and baseline ACR > 63.10 mg/g.


Assuntos
Albuminúria/urina , Creatinina/urina , Diabetes Mellitus Tipo 2/complicações , Testes de Função Renal/métodos , Insuficiência Renal/diagnóstico , Insuficiência Renal/urina , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
6.
J Pharmacol Exp Ther ; 374(3): 428-437, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32561685

RESUMO

Renal inflammation is a final common pathway of chronic kidney disease (CKD), and its progression can be used to effectively gauge the degree of renal dysfunction. Inflammatory mechanisms contribute to glomerulosclerosis and tubulointerstitial fibrosis, which are hallmarks of CKD leading to end-stage renal disease. Receptor-interacting protein kinase 2 (RIP2) is largely committed to nucleotide-binding oligomerization domain signaling as a direct effector and transmits nuclear factor-κB (NF-κB)-mediated proinflammatory cytokine production. In the present study, we hypothesized that if inflammation via RIP2 and NF-κB signaling plays an important role in renal failure, then the anti-inflammatory effect of RIP2 inhibitors should be effective in improving CKD. To determine its pharmacologic potency, we investigated the renoprotective properties of the novel RIP2 inhibitor AS3334034 [7-methoxy-6-(2-methylpropane-2-sulfonyl)-N-(4-methyl-1H-pyrazol-3-yl)quinolin-4-amine] in uninephrectomized adriamycin-induced CKD rats. Six weeks' repeated administration of AS3334034 (10 mg/kg, once daily) significantly reduced urinary protein excretion and prevented the development of glomerulosclerosis and tubulointerstitial fibrosis. In addition, AS3334034 showed beneficial effects on renal function, as demonstrated by a decrease in levels of plasma creatinine and blood urea nitrogen and attenuation of a decline in creatinine clearance. Furthermore, AS3334034 significantly attenuated inflammation, renal apoptosis, and glomerular podocyte loss. These results suggest that the RIP2 inhibitor AS3334034 suppresses the progression of chronic renal failure via an anti-inflammatory effect and is therefore potentially useful in treating patients with CKD. SIGNIFICANCE STATEMENT: The receptor-interacting protein kinase 2 (RIP2) inhibitor AS3334034 suppresses the progression of chronic renal failure via an anti-inflammatory effect, suggesting that the nucleotide-binding oligomerization domain-RIP2 axis might play a crucial role in the pathogenesis of inflammatory kidney diseases. AS3334034 is expected to be potentially useful in the treatment of patients with chronic kidney disease.


Assuntos
Doxorrubicina/farmacologia , Rim/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Proteína Serina-Treonina Quinase 2 de Interação com Receptor/antagonistas & inibidores , Proteína Serina-Treonina Quinase 2 de Interação com Receptor/metabolismo , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Progressão da Doença , Inflamação/sangue , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Rim/metabolismo , Testes de Função Renal/métodos , Masculino , NF-kappa B/metabolismo , Ratos , Ratos Wistar , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/metabolismo , Transdução de Sinais/efeitos dos fármacos
7.
Clin Nephrol ; 94(1): 43-49, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32383639

RESUMO

The purpose of this NephEd contribution is to introduce a generic method for analyzing plasma concentrations ([x]p). The method is applicable to substances that are filtered by glomeruli, reabsorbed or secreted by tubules, and excreted in urine. The equality from which the method follows states that the filtration rate of substance x is the sum of excretion and net reabsorption rates of x (Fx = Ex + TRx). If x is completely ultrafilterable, Fx = GFR[x]p, and [x]p = Ex/GFR + TRx/GFR. If creatinine clearance (Ccr) is substituted for GFR, Ex/Ccr simplifies to [x]u[cr]p/[cr]u, which can be calculated from measurements in simultaneous aliquots of serum and urine. TRx/Ccr is then deduced as [x]p - Ex/Ccr. The ratios Ex/Ccr and TRx/Ccr - the determinants of [x]p - quantify the amounts of x excreted and reabsorbed per volume of filtrate. If [x]p is abnormal, the generic method identifies which of the determinants is creating the abnormality. If [x]p is normal despite disruptive circumstances, e.g., a reduced GFR, the method elucidates the preservation of normalcy. Herein, we develop these concepts and illustrate their practical utility.


Assuntos
Biomarcadores/sangue , Taxa de Filtração Glomerular/fisiologia , Testes de Função Renal/métodos , Glomérulos Renais/fisiologia , Biomarcadores/metabolismo , Biomarcadores/urina , Creatinina/sangue , Creatinina/metabolismo , Creatinina/urina , Humanos , Taxa de Depuração Metabólica/fisiologia
8.
Neurology ; 94(22): e2361-e2372, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32303651

RESUMO

OBJECTIVE: To test the association between reduced kidney function (assessed by estimated glomerular filtration rate [eGFR] and cystatin C [CysC]) and kidney damage (assessed by urinary albumin-to-creatinine ratio [ACR]) and intracranial atherosclerotic disease (ICAD) by high-resolution vessel wall MRI (VWMRI) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS: We conducted a cross-sectional analysis of ARIC participants with data on kidney measures and VWMRI in 2011 to 2013. The main outcomes were presence of intracranial plaques and luminal stenosis. Multivariable models were adjusted for demographics, cardiovascular risk factors, and use of antithrombotic medications. RESULTS: A total of 1,762 participants (mean ± SD age, 76.3 ± 5.3) were included. eGFR based on CysC (eGFRcysc) <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) was associated with plaque presence (adjusted odds ratio [OR] 1.29, 95% confidence interval [CI] 1.04-1.60), any detectable stenosis (adjusted OR 1.31, 95% CI 1.04-1.63), and >70% stenosis or occlusion (adjusted OR 2.15, 95% CI 1.32-3.50). Neither ACR nor CysC showed statistically significant associations with ICAD features in adjusted models. In adjusted multinomial models, participants with eGFRcysc <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) had an increased OR of 1.41 (95% CI 1.06-1.87) for having 1 plaque (vs none) but no significant increase for multiple plaques; ACR ≥30 was associated with moderate (50%-70%) stenosis (OR 2.01, 95% CI 1.14-3.55) vs absent or less than 50% stenosis. CONCLUSION: In community-dwelling older adults, reduced kidney function or elevated kidney damage was associated with ICAD measured by VWMRI. This finding may help to better identify a population at high risk for ICAD.


Assuntos
Vida Independente , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Testes de Estado Mental e Demência , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Arteriosclerose Intracraniana/sangue , Testes de Função Renal/métodos , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Fatores de Risco
9.
Clin Exp Hypertens ; 42(6): 565-570, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32174191

RESUMO

IMPORTANCE: In several studies, homocysteine (hcy) is a documented risk for predicting renal function decline. The differential effects between various levels of hcy have yet to be quantified. METHODS: In this retrospective cohort study, data was obtained from patients admitted to our hospital from Jan. 2015 to Apr. 2019. Hyperhomocysteinemia is defined as serum hcy concentration >15 µmol/L. Study population eligible subjects included those who had a diagnostic hypertension. The endpoint event was defined as a fall in eGFR between the follow-up and baseline. Logistic regression models were used to examine the related ratio risk results. Cox models were performed to explore the effect of study groups on survival. The significant level was set at a P value of <0.05. RESULTS: A total of 7,240 patients presented over 3,564 person-years and were retrospectively enrolled in this study. Overall, 1,145 patients had a hypertension grade 1 [15.8%], 2,455 hypertension grade 2 [33.9%], and 3,640 hypertension grade 3 [50.27%]. Among patients who developed hyperhomocysteinemia (3,604 patients), their renal function had a higher long-term rate of decline (P= .005, hazard ratio (HR) = 1.097, 95% confidence interval (CI) [1.028, 1.171]), compared to patients who didn't developed hyperhomocysteinemia (3,636 patients). After adjusting for covariables, patients' (hcy > 15 µmol/L group) eGFR decreasing had a more hazard ratio (P = .002, aHR= 1.112; 95%CI [1.039, 1.190]). Compared with the serum hcy ≤ 10 µmol/L patients, their renal function decline ratio was higher in the 10 µmol/L < hcy ≤ 15 µmol/L group (P = .008, HR= 1.195, 95% CI [1.048,1.364]), 15 µmol/L < hcy ≤ 20 µmol/L group (P = .000, HR= 1.400, 95%CI [1.227,1.597]), and hcy > 20 µmol/L group (P = .000, HR = 1.475, 95%CI [1.305,1.667]). CONCLUSION: Elevated hcy concentration increases the risk of renal function decline in hypertensive patients. Hcy concentration might also be considered as an important factor in risk stratification of the renal function for hypertensive patients.


Assuntos
Homocisteína/sangue , Hiper-Homocisteinemia , Hipertensão , Insuficiência Renal , Adulto , China/epidemiologia , Correlação de Dados , Feminino , Taxa de Filtração Glomerular , Humanos , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/epidemiologia , Hiper-Homocisteinemia/etiologia , Hipertensão/sangue , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/sangue , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Fatores de Risco
10.
Transplant Proc ; 52(3): 748-753, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32199650

RESUMO

OBJECTIVE: To develop a radial basis function (RBF) neural network and investigate its performance in the estimation of glomerular filtration rate (GFR) for patients with chronic kidney disease. METHODS: A total of 651 patients with chronic kidney disease were enrolled in this study. The GFR measured by 99mTc-DTPA renal dynamic imaging was used as the standard GFR. The RBF neural network model was established and the performance prediction GFR value was verified. It was found that the RBF neural network could better evaluate the GFR of patients with chronic kidney disease stage 2-5, which is superior to the Modification of Diet in Renal Disease equation. CONCLUSIONS: The RBF neural network evaluated GFR significantly for patients with chronic kidney disease stages 2-5, and it showed no difference with the 99mTc-DTPA renal dynamic imaging method, and it can be used for estimated GFR evaluation.


Assuntos
Taxa de Filtração Glomerular , Testes de Função Renal/métodos , Redes Neurais de Computação , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade
11.
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
12.
BJOG ; 127(7): 897-904, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31961472

RESUMO

OBJECTIVE: To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making. DESIGN: A prospective cohort study. SETTING: Fistula Care Centre in Malawi. POPULATION: Women with an obstetric fistula. METHODS: Baseline creatinine testing and renal ultrasounds were performed. Surgeons completed a short questionnaire on the usefulness of creatinine and renal ultrasound on operative decision making. MAIN OUTCOME MEASURES: Baseline creatinine and renal ultrasound findings. RESULTS: Four surgeons performed operations on 85 patients. The mean creatinine in patients with vesicovaginal fistulas (VVF) was 0.60 ng/ml versus patients with uretero-vaginal fistulas (UVF) (0.79 ng/ml, P = 0.012). When a grade 3 or more hydronephrosis is absent on renal ultrasound, the negative predictive value of the presence of UVF is 93.3% (95% confidence interval [CI] 88.6-96.2) with a specificity of 97.2% (95% CI 90.3-99.6). In cases of UVF, surgeons found the renal ultrasound results useful or very useful 87.5% of the time, and the creatinine useful or very useful 75% of the time. CONCLUSION: In this pilot study, most patients with obstetric fistulas presented with a normal creatinine. In the absence of a grade 3 hydronephrosis or above on renal ultrasound, the probability of not having a UVF is 93.3%. Surgeons should consider performing preoperative renal ultrasound testing in all patients with an obstetric fistula, particularly in women with a prior laparotomy, as this population has risk factors for ureterovaginal fistula. TWEETABLE ABSTRACT: Most patients with obstetric fistulas have normal renal function. Preoperative renal ultrasounds should be performed.


Assuntos
Rim/diagnóstico por imagem , Complicações do Trabalho de Parto , Fístula Urinária , Fístula Vesicovaginal , Adulto , Feminino , Humanos , Testes de Função Renal/métodos , Malaui/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Estudos Prospectivos , Melhoria de Qualidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia/métodos , Fístula Urinária/diagnóstico , Fístula Urinária/epidemiologia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
13.
Kidney Blood Press Res ; 45(2): 166-179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31982867

RESUMO

INTRODUCTION: An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). OBJECTIVE: The objective of the study is to determine the extent of the error of eGFR formulas compared to the mGFR in different specific clinical settings. METHODS: A total retrospectively consecutive cohort of 1,320 patients (pts) enrolled in 2 different European Hospitals (Center 1: 470 pts; Center 2: 850 pts) was collected in order to compare the most common eGFR formulas used by physicians with the most widespread mGFR methods in daily clinical practice (Iohexol Plasma Clearance -Center 1 [mGFR-iox] and Renal Scintigraphy -Center 2 [mGFR-scnt]). The study cohort was composed by urological, oncological, and nephrological pts. The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference) accuracy (as P30), and total deviation index. RESULTS: The most accurate eGFR formula in the comparison with gold standard method (Iohexol plasma clearance) in Center 1 was represented by s-creatinine and cystatin C combined Chronic Kidney Disease-Epidemiology Collaboration-cr-cy, even though the P30 is reduced (84%) under the threshold of 60 mL/min/1.73 m2. Similar results were found in Center 2, with a wider discrepancy between mGFR-scnt and eGFR formulas due to the minor accuracy of the nuclear tool in respect to the mGFR-iox. CONCLUSIONS: The loss of accuracy observed for the formulas at lower values of GFR suggests the mandatory use of gold standards methods as Iohexol Plasma Clearance to assess the correct status of renal function for critical cases. The center 2 showed lower levels of agreement between mGFR and eGFR suggesting that the errors are partially accounted for the Renal Scintigraphy technique too. In particular, we suggest the use of mGFR-iox in oncological urological and nephrological pts with an eGFR lower than 60 mL/min/1.73 m2.


Assuntos
Testes de Função Renal/métodos , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Kidney Blood Press Res ; 45(2): 331-338, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31982885

RESUMO

INTRODUCTION: Impaired cardiac function is one of the most concomitant symptoms in patients with kidney failure after long-term dialysis. In addition, the preservation of adequate perfusion pressure to the graft plays a significant role in the intraoperative management during kidney transplantation, but the use of positive inotropic drugs in kidney transplant patients has been studied less. We investigated the protective effects of renal function by means of cardiac inotropes in kidney transplant patients. METHODS: Eighty-nine patients that received kidney transplantation between April 2014 and December 2016 at Qilu Hospital were included and randomly divided into the treatment group receiving levosimendan and a control group. All kidney recipients received ABO-compatible donors. A poor outcome was defined as one of the following: delayed graft function, graft hemorrhage, or nephrectomy. RESULTS: The treatment group had a better composite outcome and the level of neutrophil gelatinase-associated lipocalin was also lower than in the control group. CONCLUSION: Inotropic drugs may play a protective role in renal function in kidney transplantation.


Assuntos
Testes de Função Renal/métodos , Transplante de Rim/métodos , Contração Miocárdica/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Mayo Clin Proc ; 95(1): 101-112, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31812252

RESUMO

OBJECTIVES: To estimate inappropriate dosing of dipeptidyl peptidase-4 (DPP-4) inhibitors and to assess the risk of emergency department visits, hypoglycemia, and mortality in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) prescribed inappropriate DPP-4 inhibitor doses because limited real-world information is available regarding rates of DPP-4 inhibitor dose adjustment and its safety in patients with T2DM and CKD. PATIENTS AND METHODS: We performed a retrospective observational cohort study of 82,332 patients aged 30 to 75 years with T2DM and CKD being treated with DPP-4 inhibitors from January 1, 2012, through December 31, 2014, using the Korean National Health Information Database. We divided the patients according to the prescription of DPP-4 inhibitor with or without dose adjustment according to estimated glomerular filtration rate. The incidences of emergency department visits, hypoglycemia, and mortality were assessed using hazard ratios estimated using Cox proportional hazards regression modeling. RESULTS: Approximately 40% of patients with T2DM and CKD were prescribed an inappropriate dose of DPP-4 inhibitor from 2009 through 2011; this proportion decreased to 24.4% in 2015. Hazard ratios (95% CIs) for inappropriate vs appropriate dosing of DPP-4 inhibitors were 1.115 (1.005-1.237) for mortality, 1.074 (1.018-1.133) for emergency department visits, and 1.192 (1.054-1.349) for severe hypoglycemia after multivariable adjustment for confounding factors. CONCLUSION: One of every 3 patients with T2DM and CKD received inappropriate dosing of DPP-4 inhibitor, which was associated with high risk of emergency department visits, severe hypoglycemia, and mortality.


Assuntos
Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipoglicemia , Prescrição Inadequada , Insuficiência Renal Crônica , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores da Dipeptidil Peptidase IV/administração & dosagem , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/epidemiologia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/estatística & dados numéricos , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Mortalidade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco
16.
Mayo Clin Proc ; 95(1): 77-89, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31630870

RESUMO

OBJECTIVE: To investigate the pharmacodynamic properties of inclisiran, a small interfering RNA targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), in individuals with normal renal function and renal impairment (RI). PATIENTS AND METHODS: The analysis included participants with normal renal function and mild, moderate, and severe RI from the phase 1 ORION-7 renal study (n=31) and the phase 2 ORION-1 study (n=247) who received 300 mg of inclisiran sodium or placebo. RESULTS: In ORION-7, PCSK9 values were reduced at day 60 in the normal renal function group (68.1%±12.4%), mild RI group (74.2%±12.3%), moderate RI group (79.8%±4.9%), and severe RI group (67.9%±16.4%) (P<.001 vs placebo in all groups). Low-density lipoprotein cholesterol levels were significantly reduced versus placebo: normal renal function, 57.6%±10.7%; mild RI, 35.1%±13.5%; moderate RI, 53.1%±21.3%; severe RI, 49.2%±26.6% (P<.001 for all). In ORION-1, PCSK9 level reductions at day 180 were 48.3% to 58.6% in the 300-mg single-dose groups and 67.3% to 73.0% in the 300-mg 2-dose groups (P<.001 vs placebo in all groups). The corresponding low-density lipoprotein cholesterol level reductions were 35.7% to 40.2% in the 300-mg single-dose groups and 50.9% to 58.0% in the 300 mg 2-dose groups (P<.001 vs placebo in all groups). In ORION-7, exposure to inclisiran was proportionally greater in individuals with increasing RI; inclisiran was undetectable in plasma 48 hours after administration in any group. CONCLUSION: The pharmacodynamic effects and safety profile of inclisiran were similar in study participants with normal and impaired renal function. Dose adjustments of inclisiran are not required in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT02597127 and NCT03159416.


Assuntos
LDL-Colesterol/sangue , Doença da Artéria Coronariana , RNA Interferente Pequeno , Insuficiência Renal , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Hipolipemiantes/administração & dosagem , Hipolipemiantes/efeitos adversos , Hipolipemiantes/farmacocinética , Testes de Função Renal/métodos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Pró-Proteína Convertase 9/antagonistas & inibidores , RNA Interferente Pequeno/administração & dosagem , RNA Interferente Pequeno/efeitos adversos , RNA Interferente Pequeno/farmacocinética , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Resultado do Tratamento
18.
Nat Rev Nephrol ; 16(1): 51-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31527790

RESUMO

Evaluation of glomerular filtration rate (GFR) is central to the assessment of kidney function in medical practice, research and public health. Measured GFR (mGFR) remains the reference standard, but the past 20 years have seen major advances in estimated GFR (eGFR). Both eGFR and mGFR are associated with error compared with true GFR. eGFR is now recommended by clinical practice guidelines, regulatory agencies and public health agencies for the initial evaluation of GFR, with measured GFR (mGFR) typically considered an important confirmatory test, depending on how accurate the assessment of GFR needs to be for application to the clinical, research or public health setting. Our approach is to use initial and confirmatory tests as needed to develop a final assessment of true GFR. We suggest that GFR evaluation might be improved by more complete implementation of current recommendations and by further research to improve the accuracy of mGFR and eGFR.


Assuntos
Lesão Renal Aguda/diagnóstico , Creatinina/metabolismo , Cistatina C/metabolismo , Taxa de Filtração Glomerular , Insuficiência Renal Crônica/diagnóstico , Lesão Renal Aguda/metabolismo , Humanos , Testes de Função Renal/métodos , Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/metabolismo
19.
Am J Kidney Dis ; 76(1): 54-62, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31879216

RESUMO

RATIONALE & OBJECTIVE: Glomerular filtration rate (GFR) estimation based on creatinine or cystatin C level is currently the standard method for assessing GFR in epidemiologic research and clinical trials despite several important and well-known limitations. Plasma iohexol clearance has been proposed as an inexpensive method for measuring GFR that could replace estimated GFR in many research projects. However, lack of standardization for iohexol assays and the use of different protocols such as single- and multiple-sample methods could potentially hamper comparisons across studies. We compared iohexol assays and GFR measurement protocols in 3 population-based European cohorts. STUDY DESIGN: Cross-sectional investigation. SETTING & PARTICIPANTS: Participants in the Age, Gene/Environment Susceptibility-Kidney Study (AGES-Kidney; n=805), the Berlin Initiative Study (BIS, n=570), and the Renal Iohexol Clearance Survey Follow-up Study (RENIS-FU; n=1,324). TESTS COMPARED: High-performance liquid chromatography analyses of iohexol. Plasma iohexol clearance calculated using single- versus multiple-sample protocols. OUTCOMES: Measures of agreement between methods. RESULTS: Frozen samples from the 3 studies were obtained and iohexol concentrations were remeasured in the laboratory at the University Hospital of North Norway. Lin's concordance correlation coefficient ρ was>0.96 and Cb (accuracy) was>0.99 for remeasured versus original serum iohexol concentrations in all 3 cohorts, and Passing-Bablok regression did not find differences between measurements, except for a slope of 1.025 (95% CI, 1.006-1.046) for the log-transformed AGES-Kidney measurements. The multiple-sample iohexol clearance measurements in AGES-Kidney and BIS were compared with single-sample GFRs derived from the same iohexol measurements. Mean bias for multiple-sample relative to single-sample GFRs in AGES-Kidney and BIS were-0.25 and-0.15mL/min, and 99% and 97% of absolute differences were within 10% of the multiple-sample result, respectively. LIMITATIONS: Lack of comparison with an independent gold-standard method. CONCLUSIONS: Agreement between the iohexol assays and clearance protocols in the 3 investigated cohorts was substantial. Our findings indicate that plasma iohexol clearance measurements can be compared across these studies.


Assuntos
Envelhecimento/sangue , Meios de Contraste/metabolismo , Taxa de Filtração Glomerular/fisiologia , Iohexol/metabolismo , Taxa de Depuração Metabólica/fisiologia , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Estudos Transversais , Feminino , Seguimentos , Interação Gene-Ambiente , Alemanha/epidemiologia , Humanos , Islândia/epidemiologia , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia
20.
Sci Rep ; 9(1): 19699, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31873143

RESUMO

Early diagnosis of kidney diseases in avian species is limited. Endogenous markers currently used in avian practice are not sensitive enough to identify early kidney failure. Consequently, alternative markers should be evaluated. To be able to evaluate these alternative markers, an accurate marker to estimate the GFR should be validated. This study determined the GFR, measured as clearance of exogenous creatinine and exo-iohexol, in six different bird species, i.e. broiler chickens, laying chickens, turkeys, Muscovy ducks, pigeons and African grey parrots (4♀/4♂). To be able to compare the six bird species, normalization to bodyweight (BW) of the GFR was performed, after a good correlation between BW and kidney weight was demonstrated (R² = 0.9836). Clearance of exo-iohexol normalized to BW (mL/min/kg) was determined in all bird species, i.e. 3.09 in broiler chickens; 2.57 in laying chickens; 1.94 in turkeys; 1.29 in pigeons; 2.60 in ducks and 1.11 in parrots. However, these results differed significantly with the clearance of exogenous creatinine: 8.41 in broiler chickens; 9.33 in laying chickens; 5.62 in turkeys; 14.97 in pigeons; 17.59 in ducks and 25.56 in parrots 25.56. Iohexol is preferred to measure the GFR, since it is not prone to tubular reabsorption nor secretion.


Assuntos
Aves/fisiologia , Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Testes de Função Renal/veterinária , Animais , Biomarcadores/sangue , Doenças das Aves/sangue , Doenças das Aves/diagnóstico , Doenças das Aves/fisiopatologia , Aves/sangue , Galinhas , Columbidae , Creatinina/administração & dosagem , Creatinina/farmacocinética , Patos , Diagnóstico Precoce , Feminino , Iohexol/administração & dosagem , Iohexol/farmacocinética , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Nefropatias/veterinária , Testes de Função Renal/métodos , Masculino , Papagaios , Especificidade da Espécie , Perus
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