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Sample records for renal glomerular filtration

  1. The renal handling of hemoglobin. I. Glomerular filtration.

    Science.gov (United States)

    Bunn, H F; Esham, W T; Bull, R W

    1969-05-01

    The glomerular filtration of hemoglobin (alpha(2)beta(2)) was studied under conditions in which its dissociation into alphabeta dimers was experimentally altered. Rats receiving hemoglobin treated with the sulfhydryl reagent bis(N-maleimidomethyl) ether (BME) showed a much lower renal excretion and prolonged plasma survival as compared with animals injected with untreated hemoglobin. Plasma disappearance was also prolonged in dogs receiving BME hemoglobin. Gel filtration data indicated that under physiological conditions, BME hemoglobin had impaired subunit dissociation. In addition, BME hemoglobin showed a very high oxygen affinity and a decreased rate of auto-oxidation. Glomerular filtration was enhanced under conditions which favor the dissociation of hemoglobin into dimers. Cat hemoglobin, which forms subunits much more extensively than canine hemoglobin, was excreted more readily by the rat kidney. The renal uptake of (59)Fe hemoglobin injected intra-arterially into rabbits varied inversely with the concentration of the injected dose.

  2. Glomerular Filtration Rate Estimation in Renal and Non-Renal Solid Organ Transplantation

    DEFF Research Database (Denmark)

    Hornum, Mads; Feldt-Rasmussen, Bo

    2017-01-01

    or estimates of renal function in these patients, in order to accurately and safely dose immunosuppressive medication and perform and adjust the treatment and prophylaxis of renal dysfunction. This is a short overview and discussion of relevant studies and possible caveats of estimated glomerular filtration...... rate methods for use in renal and non-renal TX....

  3. Glomerular filtration rate

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007305.htm Glomerular filtration rate To use the sharing features on this page, please enable JavaScript. Glomerular filtration rate (GFR) is a test used to check ...

  4. Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    Hao-Jian Dong; Cheng Huang; De-Mou Luo; Jing-Guang Ye; Jun-Qing Yang; Guang Li; Jian-Fang Luo

    2015-01-01

    Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing,level of estimated glomerular filtration rate (eGFR),respectively.The different levels of eGFR,renal microcirculation markers,and RAS severity were compared with each other,to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study.Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity.The value of eGFR in RAS group was lower than that in the no RAS group,but it did not decline parallel to the progressive severity of RAS.The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency,especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR,with strong (r =-0.713,P < 0.001) and moderate (r =-0.580,P < 0.001) correlations.In the subgroup analysis of severe RAS (RAS ≥ 80%),the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR,(r =-0.827,P < 0.001) and (r =-0.672,P < 0.001) correlations,respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR,whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

  5. Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Hao-Jian Dong

    2015-01-01

    Full Text Available Background: The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS. But the gap between artery stenosis and the glomerular filtration ability is still unclear. Methods: Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR, respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. Results: A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50% and no RAS group (RAS < 50% or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC and urinary microalbumin to creatinine ratio (mACR increased with the deterioration of eGFR, with strong (r = −0.713, P < 0.001 and moderate (r = −0.580, P < 0.001 correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%, the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = −0.827, P < 0.001 and (r = −0.672, P < 0.001 correlations, respectively. Conclusions: Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

  6. Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1999-01-01

    The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea.......The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea....

  7. Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1999-01-01

    The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea.......The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea....

  8. Association between the glomerular filtration rate of renal dysfunction and metabolic syndrome: an age-stratified analysis

    Institute of Scientific and Technical Information of China (English)

    宋慧

    2014-01-01

    Objective To explore the relationship between the renal dysfunction rate and metabolic syndrome(MS),stratified by age.Methods People took part in physical check-up in a certain tertiary hospital from March 2010to September 2012,were enrolled in this study.Estimated glomerular filtration rate(e GFR),—a renal dysfunction indicator,was calculated by modified MDRD

  9. The effects of cimetidine on creatinine excretion, glomerular filtration rate and tubular function in renal transplant recipients

    DEFF Research Database (Denmark)

    Olsen, Niels Vidiendal; Ladefoged, S D; Feldt-Rasmussen, B;

    1989-01-01

    The renal clearance of endogenous creatinine (CCr), sodium (CNa) and lithium (CLi) was determined before and after a single intravenous bolus of cimetidine in nine renal transplant recipients. The glomerular filtration rate (GFR) was measured with 125I-iothalamate clearance (CTh). The initial CCr...... of sodium decreased throughout the study (p less than 0.05); CLi was unchanged. In conclusion cimetidine, when measured during 1-h clearance periods, interferes with tubular creatinine secretion in the denervated kidney of transplant recipients without affecting the glomerular filtration rate or proximal...

  10. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality

    NARCIS (Netherlands)

    Coresh, J.; Turin, T.C.; Matsushita, K.; Sang, Y.; Ballew, S.H.; Appel, L.J.; Arima, H.; Chadban, S.J.; Cirillo, M.; Djurdjev, O.; Green, J.A.; Heine, G.H.; Inker, L.A.; Irie, F.; Ishani, A.; Ix, J.H.; Kovesdy, C.P.; Marks, A.; Ohkubo, T.; Shalev, V.; Shankar, A.; Wen, C.P.; Jong, P.E. de; Iseki, K.; Stengel, B.; Gansevoort, R.T.; Levey, A.S.; Wetzels, J.F.M.

    2014-01-01

    IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of -57% or greater) is a late event. OBJECTIVE: To characterize th

  11. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality

    NARCIS (Netherlands)

    Coresh, Josef; Turin, Tanvir Chowdhury; Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H.; Appel, Lawrence J.; Arima, Hisatomi; Chadban, Steven J.; Cirillo, Massimo; Djurdjev, Ognjenka; Green, Jamie A.; Heine, Gunnar H.; Inker, Lesley A.; Irie, Fujiko; Ishani, Areef; Ix, Joachim H.; Kovesdy, Csaba P.; Marks, Angharad; Ohkubo, Takayoshi; Shalev, Varda; Shankar, Anoop; Wen, Chi Pang; de Jong, Paul E.; Iseki, Kunitoshi; Stengel, Benedicte; Gansevoort, Ron T.; Levey, Andrew S.

    2014-01-01

    IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event. OBJECTIVE: To characterize th

  12. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

    NARCIS (Netherlands)

    Nitsch, D.; Grams, M.; Sang, Y.; Black, C.; Cirillo, M.; Djurdjev, O.; Iseki, K.; Jassal, S.K.; Kimm, H.; Kronenberg, F.; Oien, C.M.; Levey, A.S.; Levin, A.; Woodward, M.; Hemmelgarn, B.R.; Wetzels, J.F.

    2013-01-01

    OBJECTIVE: To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. DESIGN: Random effects meta-analysis using pooled individual participant data. SETTI

  13. Angiotensin II and renal prostaglandin release in the dog. Interactions in controlling renal blood flow and glomerular filtration rate.

    Science.gov (United States)

    Bugge, J F; Stokke, E S

    1994-04-01

    The relationship between angiotensin II and renal prostaglandins, and their interactions in controlling renal blood flow (RBF) and glomerular filtration rate (GFR) were investigated in 18 anaesthetized dogs with acutely denervated kidneys. Intrarenal angiotensin II infusion increased renal PGE2 release (veno-arterial concentration difference times renal plasma flow) from 1.7 +/- 0.9 to 9.1 +/- 0.4 and 6-keto-PGF1 alpha release from 0.1 +/- 0.1 to 5.3 +/- 2.1 pmol min-1. An angiotensin II induced reduction in RBF of 20% did not measurably change GFR whereas a 30% reduction reduced GFR by 18 +/- 8%. Blockade of prostaglandin synthesis approximately doubled the vasoconstrictory action of angiotensin II, and all reductions in RBF were accompanied by parallel reductions in GFR. When prostaglandin release was stimulated by infusion of arachidonic acid (46.8 +/- 13.3 and 15.9 +/- 5.4 pmol min-1 for PGE2, and 6-keto-PGF1 alpha, respectively), angiotensin II did not change prostaglandin release, but had similar effects on the relationship between RBF and GFR as during control. In an ureteral occlusion model with stopped glomerular filtration measurements of ureteral pressure and intrarenal venous pressure permitted calculations of afferent and efferent vascular resistances. Until RBF was reduced by 25-30% angiotensin II increased both afferent and efferent resistances almost equally, keeping the ureteral pressure constant. At greater reductions in RBF, afferent resistance increased more than the efferent leading to reductions in ureteral pressure. This pattern was not changed by blockade of prostaglandin synthesis indicating no influence of prostaglandins on the distribution of afferent and efferent vascular resistances during angiotensin II infusion. In this ureteral occlusion model glomerular effects of angiotensin II will not be detected, and it might well be that the shift from an effect predominantly on RBF to a combined effect on both RBF and GFR induced by inhibition

  14. Metabolic and Hormonal Determinants of Glomerular Filtration Rate and Renal Hemodynamics in Severely Obese Individuals

    Directory of Open Access Journals (Sweden)

    Edoardo Vitolo

    2016-10-01

    Full Text Available Objective: Renal function is often compromised in severe obesity. A true measurement of glomerular filtration rate (GFR is unusual, and how estimation formulae (EstForm perform in such individuals is unclear. We characterized renal function and hemodynamics in severely obese individuals, assessing the reliability of EstForm. Methods: We measured GFR (mGFR by iohexol plasma clearance, renal plasma flow (RPF by 123I-ortho-iodo-hippurate, basal and stimulated vascular renal indices, endothelium-dependent and -independent vasodilation using flow-mediated dilation (FMD as well as metabolic and hormonal profile in morbid, otherwise healthy, obese subjects. Results: Compared with mGFR, the better performing EstForm was CKD-EPI (5.3 ml/min/1.73 m2 bias by Bland-Altman analysis. mGFR was directly related with RPF, total and incremental glucose AUC, and inversely with PTH and h8 cortisol. Patients with mGFR below the median shown significantly higher PTH and lower vitamin D3. Basal or dynamic renal resistive index, FMD, pulse wave velocity were not related with mGFR. In an adjusted regression model, renal diameter and plasma flow remained related with mGFR (R2 = 0.67, accounting for 15% and 21% of mGFR variance, respectively. Conclusions: CKD-EPI formula should be preferred in morbid obesity; glucose increments during oral glucose tolerance test correlate with hyperfiltration; RPF and diameter are independent determinants of mGFR; slightly high PTH values, frequent in obesity, might influence mGFR.

  15. The effects of cimetidine on creatinine excretion, glomerular filtration rate and tubular function in renal transplant recipients

    DEFF Research Database (Denmark)

    Olsen, N V; Ladefoged, S D; Feldt-Rasmussen, B;

    1989-01-01

    The renal clearance of endogenous creatinine (CCr), sodium (CNa) and lithium (CLi) was determined before and after a single intravenous bolus of cimetidine in nine renal transplant recipients. The glomerular filtration rate (GFR) was measured with 125I-iothalamate clearance (CTh). The initial CCr...... of 65 ml/min (median) was reduced to a nadir of 46 ml/min (p less than 0.01) during the first 2 h after infusion of cimetidine. GFR remained unchanged, and thus the fractional clearance of creatinine (CCr/CTh) was reduced from 1.43 (median) to 1.03 (p less than 0.01). CNa and the fractional excretion...... of sodium decreased throughout the study (p less than 0.05); CLi was unchanged. In conclusion cimetidine, when measured during 1-h clearance periods, interferes with tubular creatinine secretion in the denervated kidney of transplant recipients without affecting the glomerular filtration rate or proximal...

  16. Effect of Cisplatin on Glomerular Filtration Rate and Effective Renal Plasma Flow

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sang Moo; Hong, Sung Woon; Kim, Young Hyun; Hong, Weon Seon; Song, Jae Kwan; Kim, Young Whan; Lee, Jhin Oh; Kang, Tae Woong [Korea Cancer Canter Hospital, Seoul (Korea, Republic of)

    1989-03-15

    While cisplatin has been widely used in the treatment of a variety of cancers, nephrotoxicity is one of the major problems which frequently limit clinical usefulness of cisplatin. This study has been conducted to investigate nephrotoxicity of cisplatin in terms of changes in glomerular filtration rate (GFR) and effective renal plasma flow (EFPF) measured by the simultaneous use of {sup 99m}Tc-DTPP and {sup 131}I-OIH, before and after administration of cisplatin, in 12 patients with lung cancer and four patients with esophageal cancer. Cisplatin was administrated at total doses of 75-100 mg/m{sup 2} with two hour hydration and diuresis method. GFR determined by the use of {sup 99m}Tc-DTPA had a good correlation with 24-hour creatinine clearance rate (r=0.77, p<0.001). GFR and filtration fraction decreased immediately after administration of cisplatin, however, they showed a tendency to be in completely recovered four weeks after administration. ERPF was not changed immediately after and four weeks after administration of cisplatin. GFR before and immediately after administration of cisplatin were analyzed with regard to age, sex, performance status, previous administration of cisplatin and method of administration. None of these factors had any influence on the rate of decrease in GFR except method of administration. Administration of cisplatin as a single dose lowered GFR more compared with that as divided doses. In this study, we have also demonstrated that the simultaneous use of {sup 99m}Tc-DTPA and {sup 131}I-OIH was a useful tool for the measurement of GFR and ERPF respectively.

  17. Associations between proteinuria, systemic hypertension and glomerular filtration rate in dogs with renal and non-renal diseases.

    Science.gov (United States)

    Wehner, A; Hartmann, K; Hirschberger, J

    2008-02-02

    Proteinuria and systemic hypertension are well recognised risk factors in chronic renal failure (CRF). They are consequences of renal disease but also lead to a further loss of functional kidney tissue. The objectives of this study were to investigate the associations between proteinuria, systemic hypertension and glomerular filtration rate (GFR) in dogs with naturally occurring renal and non-renal diseases, and to determine whether proteinuria and hypertension were associated with shorter survival times in dogs with CRF. Measurements of exogenous creatinine plasma clearance (ECPC), urine protein:creatinine ratio (UPC), and Doppler sonographic measurements of systolic blood pressure (SBP) were made in 60 dogs with various diseases. There was a weak but significant inverse correlation between UPC and ECPC, a significant inverse correlation between SBP and ECPC and a weak but significant positive correlation between UPC and SBP. Some of the dogs with CRF were proteinuric and almost all were hypertensive. Neoplasia was commonly associated with proteinuria in the dogs with a normal ECPC. CRF was the most common cause leading to hypertension. In the dogs with CRF, hypertension and marked proteinuria were associated with significantly shorter survival times.

  18. The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate.

    Science.gov (United States)

    Damkjaer, M; Wang, T; Brøndum, E; Østergaard, K H; Baandrup, U; Hørlyck, A; Hasenkam, J M; Smerup, M; Funder, J; Marcussen, N; Danielsen, C C; Bertelsen, M F; Grøndahl, C; Pedersen, M; Agger, P; Candy, G; Aalkjaer, C; Bie, P

    2015-08-01

    The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary adaption in the giraffe kidney allows normal for size renal haemodynamics and glomerular filtration rate (GFR) despite a MAP double that of other mammals. Fourteen anaesthetized giraffes were instrumented with vascular and bladder catheters to measure glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological characteristics of vascular and renal tissues were determined. GFR averaged 342 ± 99 mL min(-1) and ERPF 1252 ± 305 mL min(-1) . RIHP varied between 45 and 140 mmHg. Renal pelvic pressure was 39 ± 2 mmHg and renal venous pressure 32 ± 4 mmHg. A valve-like structure at the junction of the renal and vena cava generated a pressure drop of 12 ± 2 mmHg. RI was 0.27. The renal capsule was durable with a calculated burst pressure of 600 mmHg. Plasma renin and AngII were 2.6 ± 0.5 mIU L(-1) and 9.1 ± 1.5 pg mL(-1) respectively. In giraffes, GFR, ERPF and RI appear much lower than expected based on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP. © 2015 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  19. Determination of representative renal depth for accurate attenuation corred in measurement of glomerular filtration rate in transplanted kidney

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    Oh, Soon Nam; Kim, Sung Hoon; Rha, Sung Eun; Chung, Yong An; Yoo, Ie Ryung; Sohn, Hyung Sun; Lee, Sung Young; Chung, Soo Kyo [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2002-08-01

    To measure reliable glomerular filtration rate by using the representative values of transplanted renal depths, which are measured with ultrasonography. We included 54 patients (26 men, 28 women), with having both renal scintigraphy and ultrasonography after renal transplantation. We measured DFR with Gates' method using the renal depth measured by ultrasonography, and median and mean ones in each patient. We compared GFR derived from ultrasonography-measured renal depth with GFR derived from median and mean renal depths. The correlation coefficients were obtained among GFR derived from ultrasonography-measured renal depths, median and mean renal depth under linear regression analysis. We determined whether GFR derived from median or mean renal depth could substitute GFR derived from ultrasonography-measured renal depth with Bland-Altman method. We analyze the expected errors of the GFR using representative renal depth in terms of age, sex, weight, height, creatinine value, and body surface. The transplanted renal depths range from 3.20 cm to 5.96 cm. The mean value and standard deviation of renal depths measured by ultrasonography are 4.09{+-}0.65 cm in men, and 4.24{+-}0.78 cm in women. The median value of renal depths measured by ultrasonography is 4.36 cm in men and 4.14 cm in women. The GFR derived from median renal depth is more consistent with GFR derived from ultrasonography-measured renal depth than GFR derived from mean renal depth. Differences of GFR derived from median and ultrasonography-measured renal depth are not significantly different in the groups classified with creatinine value, age, sex, height, weight and body surface. When median value is adapted as a representative renal depth, we could obtain reliable GFR in transplanted kidney simply.

  20. Glomerular Filtration Rate Estimation in Renal and Non-Renal Solid Organ Transplantation

    DEFF Research Database (Denmark)

    Hornum, Mads; Feldt-Rasmussen, Bo

    2017-01-01

    Following transplantation (TX) of both renal and non-renal organs, a large proportion of patients have renal dysfunction. There are multiple causes for this. Chronic nephrotoxicity and high doses of calcineurin inhibitors are important factors. Preoperative and perioperative factors like...... hypertension, hypotension, drugs and infections may play a causative role as well. Organ-specific causes include hepatorenal syndrome, cirrhosis, low cardiac function, low respiratory function and diabetes developed both before and after TX. It is important to be able to perform precise and valid measurements...

  1. Renal uptake of dimercaptosuccinic acid and glomerular filtration rate in chronic nephropathy at angiotensin converting enzyme inhibition

    DEFF Research Database (Denmark)

    Kamper, A L; Thomsen, H S; Nielsen, S L;

    1990-01-01

    Glomerular filtration rate (GFR) and renal uptake of dimercaptosuccinic acid (DMSA) were measured in 31 patients with progressive chronic nephropathy before and immediately after the start of treatment with angiotensin converting enzyme (ACE) inhibitor in order to control adverse effects on kidney...... function. Scintigrams of the kidneys showed an unaltered distribution of DMSA during treatment. GFR estimated by 51Cr-EDTA plasma clearance fell by 14% (P less than 0.01), but renal uptake of 99mTc-DMSA increased by 10% (P less than 0.01). It is concluded that DMSA in chronic renal failure is mainly taken...... up by the tubular cells from the peritubular capillaries since the uptake was unaffected by the acute decrease in GFR....

  2. Effect of Proteinuria and Glomerular Filtration Rate on Renal Outcome in Patients with Biopsy-Proven Benign Nephrosclerosis.

    Science.gov (United States)

    Sumida, Keiichi; Hoshino, Junichi; Ueno, Toshiharu; Mise, Koki; Hayami, Noriko; Suwabe, Tatsuya; Kawada, Masahiro; Imafuku, Aya; Hiramatsu, Rikako; Hasegawa, Eiko; Yamanouchi, Masayuki; Sawa, Naoki; Fujii, Takeshi; Ohashi, Kenichi; Takaichi, Kenmei; Ubara, Yoshifumi

    2016-01-01

    Reduced estimated glomerular filtration rate (eGFR) and proteinuria are risk factors for end-stage renal disease (ESRD), of which benign nephrosclerosis is a common cause. However, few biopsy-based studies have assessed these associations. We performed retrospective cohort study of 182 Japanese patients who underwent renal biopsy from June 1985 through March 2014 and who were diagnosed with benign nephrosclerosis. Competing risk regression analyses were used to investigate the effect of eGFR and proteinuria levels at the time of renal biopsy on the risk for renal events (ESRD or a 50% decline in eGFR from baseline). During a median 5.8-year follow-up, 63 (34.6%) patients experienced renal events. The incidence of renal events increased with lower baseline eGFR and greater baseline proteinuria levels. After adjustment for baseline covariates, lower eGFR levels (subhazard ratios [SHRs], 1.30; 95% confidence interval [CI], 1.01-1.67, per 10 mL/min/1.73 m2) and higher proteinuria levels (SHR, 1.52; 95% CI, 1.23-1.87, per 1.0 g/day) at the time of renal biopsy were associated independently with higher risk for renal events. Lower levels of serum albumin (SHR, 2.07; 95% CI, 1.20-3.55 per 1.0 g/dL) were also associated with renal events. Patients with both eGFR proteinuria ≥0.5 g/day had a 26.7-fold higher risk (95% CI, 3.97-179.4) of renal events than patients with both eGFR ≥60 mL/min/1.73 m2 and proteinuria proteinuria as well as lower serum albumin at the time of renal biopsy are independent risk factors for renal events among patients with biopsy-proven benign nephrosclerosis.

  3. A Pilot Study to Evaluate Renal Hemodynamics in Cirrhosis by Simultaneous Glomerular Filtration Rate, Renal Plasma Flow, Renal Resistive Indices and Biomarkers Measurements

    Science.gov (United States)

    Mindikoglu, Ayse L.; Dowling, Thomas C.; Wong-You-Cheong, Jade J.; Christenson, Robert H.; Magder, Laurence S.; Hutson, William R.; Seliger, Stephen L.; Weir, Matthew R.

    2014-01-01

    Background Renal hemodynamic measurements are complicated to perform in patients with cirrhosis; yet they provide the best measure of risk to predict hepatorenal syndrome (HRS). Currently, there are no established biomarkers of altered renal hemodynamics in cirrhosis validated by measured renal hemodynamics. Methods In this pilot study, simultaneous measurements of glomerular filtration rate (GFR), renal plasma flow (RPF), renal resistive indices and biomarkers were performed to evaluate renal hemodynamic alterations in 10 patients with cirrhosis (3 patients without ascites, 5 with diuretic sensitive and 2 diuretic refractory ascites). Results Patients with diuretic refractory ascites had the lowest mean GFR (36.5 ml/min/1.73m2) and RPF (133.6 ml/min/1.73m2) when compared to those without ascites (GFR=82.9 ml/min/1.73m2, RPF=229.9 ml/min/1.73m2) and with diuretic-sensitive ascites (GFR=82.3 ml/min/1.73m2, RPF=344.1 ml/min/1.73m2). A higher mean filtration fraction (FF= GFR/RPF=0.36) was noted among those without ascites compared to those with ascites. Higher FF in patients without ascites is most likely secondary to the vasoconstriction in the efferent glomerular arterioles (normal FF≃0.20). In general, renal resistive indices were inversely related to FF. While patients with ascites had lower FF and higher right kidney main and arcuate artery resistive indices, those without ascites had higher FF and lower right kidney main and arcuate artery resistive indices. While cystatin C and beta-2 microglobulin performed better compared to Cr in estimating RPF; beta-trace protein, beta-2 microglobulin, SDMA, and (SDMA+ADMA) performed better in estimating right kidney arcuate artery resistive index. Conclusion The results of this pilot study showed that identification of non-invasive biomarkers of reduced RPF and increased renal resistive indices can identify cirrhotics at risk for HRS at a stage more amenable to therapeutic intervention, and reduce mortality from kidney

  4. Correlation of whole kidney hypertrophy with glomerular over-filtration in live, gender-mismatched renal transplant allografts.

    Science.gov (United States)

    Yanishi, Masaaki; Tsukaguchi, Hiroyasu; Huan, Nguyen Thanh; Koito, Yuya; Taniguchi, Hisanori; Yoshida, Kenji; Mishima, Takao; Sugi, Motohiko; Kinoshita, Hidefumi; Matsuda, Tadashi

    2016-08-30

    Optimizing nephron supply to recipient demand is a non-immunologic determinant of renal allograft outcome. Nephron reduction is usually caused by physical donor-recipient mismatch, but its pathologic relevance remains to be determined. Thirty-one recipients of living donor renal transplants were divided into three subgroups: those who received transplants from the same gender (n = 6, Group 1) and those who underwent male-to-female (n = 8, Group 2) and female-to-male (n = 17, Group 3) transplants. Renal mass was evaluated by three-dimensional computed tomography (3D-CT) volumetry before and one year after transplantation. Glomerular volume was determined from protocol biopsies obtained one hour and one year after transplantation. Histologically determined glomerular volume in biopsied tissues showed a significant linear correlation with allograft size on 3D-CT volumetry (p Mismatches in body weight, glomerular volume and kidney volume ratios were significantly greater in female-to-male (Group 3) than in male-to-female (Group 2) transplants (p < 0.001 each). Despite the two groups having nearly equal graft filtration rates one year after transplantation, proteinuria rate was three-fold higher in Group 3 than in Group 2 (p < 0.001). These findings suggest that too small graft size, frequent in female-to-male transplants, could cause hypertrophy in both kidneys and glomeruli, thereby affecting allograft function and survival. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. An orally active adenosine A1 receptor antagonist, FK838, increases renal excretion and maintains glomerular filtration rate in furosemide-resistant rats

    Science.gov (United States)

    Schnackenberg, Christine G; Merz, Emily; Brooks, David P

    2003-01-01

    Loop and thiazide diuretics are common therapeutic agents for the treatment of sodium retention and oedema. However, resistance to diuretics and decreases in renal function can develop during diuretic therapy. Adenosine causes renal vasoconstriction, sodium reabsorption, and participates in the tubuloglomerular feedback mechanism for the regulation of glomerular filtration rate.We tested the hypothesis that the selective adenosine A1 receptor antagonist FK838 is orally active and causes diuresis and natriuresis, but maintains glomerular filtration rate in normal rats or in rats with furosemide resistance.In normal male Sprague – Dawley rats, FK838 dose-dependently increased urine flow and sodium and chloride excretion while sparing potassium. In combination with furosemide, FK838 enhanced the diuretic and natriuretic actions of furosemide to the same extent as hydrochlorothiazide and did not increase the potassium loss in normal rats. In furosemide-resistant rats, FK838 increased urine flow and electrolyte excretion to a greater extent than hydrochlorothiazide. In addition, hydrochlorothiazide significantly decreased glomerular filtration rate, whereas FK838 maintained glomerular filtration rate in furosemide-resistant rats.This study shows that the adenosine A1 receptor antagonist FK838 is orally active and causes potent diuresis and natriuresis and maintains glomerular filtration rate in normal or furosemide-resistant rats. Adenosine A1 receptor antagonists may be novel therapeutics for the treatment of oedema in normal or otherwise diuretic-resistant patients. PMID:12922924

  6. Association of glomerular filtration rate with slow coronary flow in patients with normal to mildly impaired renal function.

    Science.gov (United States)

    Akin, Fatih; Celik, Omer; Ayça, Burak; Yalçin, Ahmet Arif; Altun, Ibrahim; Köse, Nuri

    2014-10-01

    We evaluated the association between estimated glomerular filtration rate (eGFR) and slow coronary flow (SCF) in patients with normal to mildly impaired renal function; 211 patients with angiographically proven SCF and 219 controls were studied. Patients were categorized based on the angiographic findings as with or without SCF. We used the Modification of Diet in Renal Disease equation to calculate eGFR. The frequency of mildly decreased eGFR, serum uric acid levels, and eGFR was higher in the SCF group. Patients with mildly impaired renal function had higher thrombolysis in myocardial infarction frame counts in 3 major coronary arteries. In logistic regression analysis, uric acid (odds ratio [OR] = 1.323, 95% confidence interval [CI] = 1.109-1.572, P = .002) and eGFR (OR = 0.972, 95% CI = 0.957-0.987, P < .001) were independent correlates of SCF. In conclusion, eGFR was significantly correlated with SCF in patients with normal to mildly impaired renal function.

  7. A short-term antihypertensive treatment-induced fall in glomerular filtration rate predicts long-term stability of renal function

    NARCIS (Netherlands)

    Apperloo, AJ; deZeeuw, D; deJong, PE

    1997-01-01

    In long-term intervention studies on renal function outcome an initial decline in the glomerular filtration rate (GFR) may occur after starting therapy. If this initial GFR decline is the result of a treatment-induced hemodynamic change reflecting a fall in intraglomerular pressure, it should be rev

  8. Glomerular filtration rate measured by 51Cr-EDTA clearance: evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Anna Alice Rolim Chaves

    2010-01-01

    Full Text Available INTRODUCTION: Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using 51Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS: This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21 and without renal artery stenosis, (n=20. In vitro glomerular filtration rate analysis (51Cr-EDTA and 99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS: The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m² in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m² in the group without renal artery stenosis (p=0.04. Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/kg/1.73m², p=0.001 and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m², p=0.68. Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA did not show

  9. Glomerular Filtration Rate Measured by 51Cr-EDTA Clearance: Evaluation of Captopril-Induced Changes in Hypertensive Patients with and without Renal Artery Stenosis

    Science.gov (United States)

    Chaves, Anna Alice Rolim; Buchpiguel, Carlos Alberto; Praxedes, Jose Nery; Bortolotto, Luiz Aparecido; Sapienza, Marcelo Tatit

    2010-01-01

    INTRODUCTION: Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using 51Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS: This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis (51Cr-EDTA) and 99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS: The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m2 in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m2 in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/ kg/1.73m2, p=0.001) and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m2, p=0.68). Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA) did not show significant

  10. Glomerular filtration rate measured by {sup 51}Cr-EDTA clearance: evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Chaves, Anna Alice Rolim; Buchpiguel, Carlos Alberto; Praxedes, Jose Nery; Bortolotto, Luiz Aparecido; Sapienza, Marcelo Tatit, E-mail: annaalice100@yahoo.com.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Dept. de Neurologia

    2010-07-01

    Introduction: renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid ({sup 51}Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using {sup 51}Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. Methods: this prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis ({sup 51}Cr-EDTA) and {sup 99m}Tc-DMSA scintigraphy were performed before and after captopril administration in all patients. Results: the mean baseline glomerular filtration rate was 48.6+-21.8 ml/kg/1.73 m{sup 2} in the group with renal artery stenosis, which was significantly lower than the GFR of 65.1+-28.7 ml/kg/1.73m{sup 2} in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6+-14.8 ml/kg/1.73m{sup 2}, p=0.001) and an insignificant change in the group without RAS (to 62.2+-23.6 ml/kg/1.73m{sup 2}, p=0.68). Scintigraphy with technetium-99m dimercapto

  11. Factors affecting change in glomerular filtration rate after unilateral nephrectomy in living kidney donors and patients with renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hye Ok; Back, So Ra; Kim, Euy Nyong; Lee, Jang Han; Yang, Won Seok; Kim, Soon Bae; Moon, Dae Hyuk [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    We evaluated factors affecting change in glomerular filtration rate (GFR) after unilateral nephrectomy in living kidney donors and patients with renal disease. We retrospectively reviewed the 435 individuals who underwent unilateral nephrectomy in 2006. Among them, we enrolled 141 patients who had performed 99mTc-DTPA scans before and after surgery. The study population consisted of 75 living donors (M=43, F=32) and 66 patients with renal disease (M=46, F=20). We evaluated factors affecting the GFR change by multiple linear regression analysis. The renal disease group was significantly older than the donors at baseline (53.9{+-}12.9 vs. 37.8{+-}11.1yr, P<0.05) and had higher preoperative Cr level (0.95{+-}0.20 vs. 0.85{+-}0.18mg/dL, p<0.05). The mean duration of the follow-up was 7.3{+-}3.3 months, (p<0.05). The disease group and donors significantly increased the GFR after nephrectomy (43.0{+-}9.6 to 48.6{+-}12.8 vs. 46.9{+-}8.4 to 58.1{+-}12.5 ml/min, respectively, P<0.05). The disease group had significantly lesser mean GFR change than the doners. (5.6{+-}7.2 vs. 11.1{+-}8.5 ml/min, respectively, p<0.05). In the renal disease group, multiple regression analysis showed that preop Cr level and age were significantly associated with GFR change ({beta} =-12.53, p=0.003; {beta} =-0.19, p=0.004). In the donor group, age was significantly associated with the GFR change ({beta} =-0.265, p=0.002). But change of GFR was not associated with sex, preop GFR, BMI, duration of follow-up, site of nephrectomy in both groups. Age and preoperative renal function were predictive factors affecting change in GFR after unilateral nephrectomy.

  12. Fetal Renal Stem Cell Transplant in Nephrotic and Nonnephrotic Glomerulonephritis with Stage 2-4 Chronic Kidney Disease: Potential Effect on Proteinuria and Glomerular Filtration Rate.

    Science.gov (United States)

    Tuganbekova, Saltanat; Gaipov, Abduzhappar; Turebekov, Zaiyrkhan; Saparbayev, Samat; Shaimardanova, Galiya; Popova, Nadezhda; Taubaldiyeva, Zhannat; Serebrennikova, Dina; Trimova, Rakhat

    2015-11-01

    Proteinuria is a major cause of glomerulosclerosis progression in glomerular diseases, and the development of end-stage renal disease is more rapid in nephrotic patients than in nonnephrotic ones. The renal parenchyma is less regenerable because it is a tissue consisting of renal cells. Thus, stem cells obtained from fetal kidney tissue might be effective for reducing proteinuria and delaying glomerulosclerosis in these patients. This report presents preliminary data from a prospective cohort study that included 17 patients with chronic glomerulonephritis in stage 2 to 4 chronic kidney disease who completed 3 visits during 1 year of follow-up. Fetal renal stem cells (multiple cells in suspension) were injected into the patient every 6 months. Patients were divided into 2 groups according to their nephrotic status, and 24-hour maximal proteinuria was recorded for at least 6 months (first group with proteinuria proteinuria > 3.5 g/24 h). During follow-up, group 1 was observed to have stable hemoglobin and total protein levels but significantly decreased albumin levels and glomerular filtration rates. In group 2, total protein with serum albumin significantly increased, and proteinuria and glomerular filtration rates significantly decreased. There was no significant difference in glomerular filtration rate decline between groups. Treatment with fetal renal stem cells significantly decreased proteinuria in nephrotic patients. However, this outcome also might have resulted from a reduction in glomerular filtration rate. Further studies with a larger number of patients and a control group would help to achieve better results that measure the efficacy of this treatment.

  13. A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula

    Science.gov (United States)

    Shivalli, Siddharudha; Pai, B.H. Santhosh; Acharya, Koteshwara Devadasa; Gopalakrishnan, Ravichandra; Srikanth, Vivek; Reddy, Vishwanath; Haris, Arafat

    2016-01-01

    Introduction The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. Aim To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. Materials and Methods The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient’s renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. Results A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. Conclusion We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted. PMID:27042555

  14. Measurement of glomerular filtration rate, renal plasma flow, and endogenous creatinine clearance in cheetahs (Acinonyx jubatus jubatus).

    Science.gov (United States)

    Holder, Erin Hall; Citino, Scott B; Businga, Nancy; Cartier, Leslie; Brown, Scott A

    2004-06-01

    Glomerular filtration rate (GFR), renal plasma flow (RPF), and the endogenous creatinine clearance (CCr) rate were determined in 13 captive cheetahs, Acinonyx jubatus jubatus (seven females and six males, 1.5-7.5 yr of age, x = 5.02 yr), during general anesthesia with Telazol and isoflurane by measuring the urinary clearances of inulin, para-aminohipppuric acid, and endogenous creatinine, respectively. Methods to determine GFR, RPF, and endogenous CCr in captive cheetahs were evaluated, and the relationship between GFR and CCr for this species was determined. The GFR and the RPF were stable during the procedure, with mean values of 1.59+/-0.17 ml/min/kg body weight and 5.12+/-1.15 ml/min/kg body weight, respectively. Although the mean value for CCr (1.47+/-0.20 ml/min/kg body weight) was significantly less than the corresponding value for GFR, the mean difference (0.11+/-0.02 ml/min/kg weight) between the two measurements was slight, and the values were highly correlated (R2 = 0.928; P cheetahs should provide a reliable estimate of GFR, facilitating the early detection of renal disease in this species.

  15. Factors Affecting Changes in the Glomerular Filtration Rate after Unilateral Nephrectomy in Living Kidney Donors and Patients with Renal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hye Ok; Chae, Sun Young; Back, Sora; Moon, Dae Hyuk [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    We evaluated the factors affecting changes in the postoperative glomerular filtration rate (GFR) after unilateral nephrectomy in living kidney donors and patients with renal disease. We studied 141 subjects who underwent living donor nephrectomy for renal transplantation (n=75) or unilateral nephrectomy for renal diseases (n=66). The GFR of the individual kidney was determined by Tc-99m DTPA scintigraphy before and after nephrectomy. By performing multiple linear regression analysis, we evaluated the factors that are thought to affect changes in GFR, such as age, sex, body mass index (BMI), preoperative GFR, preoperative creatinine level, operated side, presence of diabetes mellitus (DM), presence of hypertension (HTN), and duration of follow-up. In both the donor nephrectomy and the disease nephrectomy groups, GFR increased significantly after nephrectomy (46.9{+-}8.4 to 58.1{+-}12.5 vs. 43.0{+-}9.6 to 48.6{+-}12.8 ml/min, p<0.05). In the donor nephrectomy group, age was significantly associated with change in GFR ({beta}=-0.3, P<0.005). In the disease nephrectomy group, HTN, preoperative creatinine level, and age were significantly associated with change in GFR ({beta}=-6.2, p<0.005; {beta}=-10.9, p<0.01; {beta}=-0.2, p<0.01, respectively). This compensatory change in GFR was not significantly related to sex, duration of follow-up, or operated side in either group. The compensatory change in the GFR of the remaining kidney declined with increasing age in both living kidney donors and patients with renal disease.

  16. Independent or synergistic relationship of proteinuria and glomerular filtration rate on patient and renal survival in patients with glomerulonephritis?

    Science.gov (United States)

    Haider, Dominik G; Masghati, Salome; Goliasch, Georg; Fuhrmann, Valentin; Soleiman, Afschin; Wolzt, Michael; Baierl, Andreas; Druml, Wilfred; Hörl, Walter H

    2014-12-01

    Glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD) identifies patients at risk for death or end-stage renal disease (ESRD). CKD staging by GFR should incorporate proteinuria to augment risk stratification. We therefore tested the predictive power of the combination of GFR with proteinuria in patients with different histologically-diagnosed types of glomerulonephritis (GN). In a retrospective analysis, 2,687 patients with different forms of GN from 123 Austrian centres were investigated. Full data sets were available from 1,892 subjects. Classes of CKD on the basis of estimated GFR (eGFR) and of proteinuria grouped as 3.5 g/24 h were tested for their association with all-cause mortality and ESRD. During a median follow-up of 130 months [interquartile range (IQR) 90; 178] 478 patients (25.3 %) died. Median eGFR was 49 ml/min/1.73 m(2) (IQR 24; 81) and proteinuria 3.8 g/24 h (IQR 1.7; 8.0). Adjusted multivariate Cox regression indicated that renal survival but not overall survival is related to proteinuria >3.5 g/24 h [as opposed to proteinuria >3.5 g/24 h exists only in patients with immunoglobulin (Ig)A GN (HR 4.93), miscellaneous GN (HR 1.74), and CKD stage 5 (HR 2.50). Additionally, proteinuria is a risk factor for renal survival in males more than in females with GN and proteinuria >3.5 g/24 h (HR 1.91). Proteinuria is a strong risk factor for renal survival particularly in patients with proteinuria >3.5 g/24 but not for all types of GN, nor for all CKD stages. Proteinuria is not a risk factor for overall survival in patients with GN.

  17. Angiopoietin-2 in chronic renal failure patients on hemodialysis: Relationship with glomerular filtration rate in the predialysis stages

    Directory of Open Access Journals (Sweden)

    Fatma A Attia

    2013-01-01

    Conclusion Circulating angiopoietin-2 is a putative marker and potential mediator of atherosclerosis, is inversely related to glomerular filtration rate, and is increased with advanced chronic kidney disease. Normolipidemia in chronic kidney disease patients does not prevent atherosclerotic burden; this is because of the presence of other markers such as angiopoietin-2.

  18. Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin-dependent diabetics

    DEFF Research Database (Denmark)

    Christiansen, JS; Gammelgaard, J; Frandsen, M;

    1981-01-01

    Glomerular filtration rate (GFR), renal plasma flow (RPF) and kidney volume were measured in thirteen male subjects (mean age 30 years) with short-term insulin-dependent diabetes (mean duration of disease 2.4 years) and fourteen normal male subjects (mean age 29 years). GFR and RPF were measured...... by constant infusion technique using I125-iothalamate and 131I-hippuran. Kidney size was determined by means of ultrasound. GFR, RPF and kidney volume were increased in the diabetic patients compared to the normal controls, 144 versus 113 ml/min X 1.73 m2 (p less than 0.0005), 627 versus 523 ml/min X 1.73 m2...... (p less than 0.0025) and 278 versus 224 ml/1.73 m2 (p less than 0.0005) respectively. Combining results from diabetic patients and controls revealed a positive correlation between kidney size and GFR (r = 0.70, p less than 0.001) and between kidney size and RPF (r = 0.61, p less than 0.001). Within...

  19. Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

    Institute of Scientific and Technical Information of China (English)

    Su-Yan Bian; Hong-Yang Guo; Ping Ye; Lei-Ming Luo; Hong-Mei Wu; Wen-Kai Xiao; Li-Ping Qi; He-Peng Yu; Liu-Fa Duan

    2012-01-01

    Objective Both decreased glomerular filtration rate (GFR) and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR ≥ 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity (PWVcf) and carotid-radial PWV (PWVcr) using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes (AIx-75) was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR (eGFR) of the study group was 100.05 ± 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVcf and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AIx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.

  20. Estimation of the Functional Renal Condition by Glomerular Filtration Rate in the Pregnant with Preeclampsy

    Directory of Open Access Journals (Sweden)

    Oksana G. Cherniukh

    2015-03-01

    Full Text Available Creatitine clearance (CC by Reberg-Tareyev test has been analyzed with an essential condition to take urine analysis during 24 hours from pregnant women with various degree of preeclampsia. To characterize the renal excretory function in the regulation of nitrogen balance the indices of proteinemia and proteinuria have been used. Probable changes of the renal functional condition depending on the volume of 24-hour diuresis have been found. The necessity to analyze the indices using the standards for the pregnant according to the trimester of pregnancy is indicated.

  1. Glomerular Filtration Barrier Assembly: An insight

    OpenAIRE

    Arif, Ehtesham; Nihalani, Deepak

    2013-01-01

    A glomerulus is the network of capillaries that resides in the Bowman’s capsule that functions as a filtration unit of kidney. The glomerular function ensures that essential plasma proteins are retained in blood and the filtrate is passed on as urine. The glomerular filtration assembly is composed of three main cellular barriers that are critical for the ultrafiltration process, the fenestrated endothelium, glomerular basement membrane and highly specialized podocytes. The podocytes along wit...

  2. An acute fall in estimated glomerular filtration rate during treatment with losartan predicts a slower decrease in long-term renal function

    DEFF Research Database (Denmark)

    Holtkamp, Frank A; de Zeeuw, Dick; Thomas, Merlin C

    2011-01-01

    Intervention in the renin-angiotensin-aldosterone-system (RAAS) is associated with slowing the progressive loss of renal function. During initiation of therapy, however, there may be an acute fall in glomerular filtration rate (GFR). We tested whether this initial fall in GFR reflects a renal hem......GFR, during losartan treatment, the slower the rate of long-term eGFR decline. Hence, interpretation of trial results relying on slope-based GFR outcomes should separate the initial drug-induced GFR change from the subsequent long-term effect on GFR....

  3. Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.

    Science.gov (United States)

    Topkara, Veli K; Coromilas, Ellie J; Garan, Arthur Reshad; Li, Randall C; Castagna, Francesco; Jennings, Douglas L; Yuzefpolskaya, Melana; Takeda, Koji; Takayama, Hiroo; Sladen, Robert N; Mancini, Donna M; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, Paolo C

    2016-12-01

    Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank Pproteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making. © 2016 American Heart Association, Inc.

  4. The giraffe kidney tolerates high arterial blood pressure by high renal interstitial pressure and low glomerular filtration rate

    DEFF Research Database (Denmark)

    Damkjær, Mads; Wang, T; Brøndum, E

    2015-01-01

    BACKGROUND: The tallest animal on earth, the giraffe (Giraffa camelopardalis) is endowed with a mean arterial blood pressure (MAP) twice that of other mammals. The kidneys reside at heart level and show no sign of hypertension-related damage. We hypothesized that a species-specific evolutionary...... on body mass. A strong renal capsule supports a RIHP, which is >10-fold that of other mammals effectively reducing the net filtration pressure and protecting against the high MAP....... renal plasma flow (ERPF). Renal interstitial hydrostatic pressure (RIHP) was assessed by inserting a needle into the medullary parenchyma. Doppler ultrasound measurements provided renal artery resistive index (RI). Hormone concentrations as well as biomechanical, structural and histological...

  5. The Glomerular Filtration Barrier: Components and Crosstalk

    OpenAIRE

    Madhav C. Menon; Chuang, Peter Y.; Cijiang John He

    2012-01-01

    The glomerular filtration barrier is a highly specialized blood filtration interface that displays a high conductance to small and midsized solutes in plasma but retains relative impermeability to macromolecules. Its integrity is maintained by physicochemical and signalling interplay among its three core constituents—the glomerular endothelial cell, the basement membrane and visceral epithelial cell (podocyte). Understanding the pathomechanisms of inherited and acquired human diseases as well...

  6. [Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients].

    Science.gov (United States)

    Cabrerizo-García, José Luis; Díez-Manglano, Jesús; García-Arilla, Ernesto; Revillo-Pinilla, Paz; Ramón-Puertas, José; Sebastián-Royo, Mariano

    2015-01-06

    The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1:>90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 renal insufficiency, especially in older women. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  7. RENAL HEMODYNAMICS AND GLOMERULAR FILTRATION RATE IN MEN AND WOMEN WITH ARTERIAL HYPERTENSION AT THE AGE OF 40-60 YEARS

    Directory of Open Access Journals (Sweden)

    I. G. Fomina

    2015-12-01

    Full Text Available Aim. To study parameters of a renal hemodynamic and the general glomerular filtration rate (GGFR and their correlations with cardiovascular risk factors (RF in patient with arterial hypertension (AH.Material and methods. 102 patients with AH (35 men and 67 women of 40-60 y.o. were involved in the study. 20 persons (10 men and 10 women with normal blood pressure (BP were included in control group. Dynamic renal angioscintigraphy was used for an estimation of a renal hemodynamic and GGFR.Results. Hypertensive women had lower renal blood flow and GGFR than these in men (p<0,000. Renal hemodynamics and GGFR in men and women did not differ in control group. Positive correlation  r=0,61; p<0,05 between GGFR and a tobacco smoking was found in hypertensive men as well as negative correlation (r=-0,41; p<0,005 between GGFR and body mass index (BMI in women.Conclusion. Renal blood flow and GGFR are lower in hypertensive women than these in men. Positive correlation between GGFR and tobacco smoking and negative correlation between GGFR and BMI were found in men and women respectively.

  8. The Glomerular Filtration Barrier: Components and Crosstalk

    Directory of Open Access Journals (Sweden)

    Madhav C. Menon

    2012-01-01

    Full Text Available The glomerular filtration barrier is a highly specialized blood filtration interface that displays a high conductance to small and midsized solutes in plasma but retains relative impermeability to macromolecules. Its integrity is maintained by physicochemical and signalling interplay among its three core constituents—the glomerular endothelial cell, the basement membrane and visceral epithelial cell (podocyte. Understanding the pathomechanisms of inherited and acquired human diseases as well as experimental injury models of this barrier have helped to unravel this interdependence. Key among the consequences of interference with the integrity of the glomerular filtration barrier is the appearance of significant amounts of proteins in the urine. Proteinuria correlates with kidney disease progression and cardiovascular mortality. With specific reference to proteinuria in human and animal disease phenotypes, the following review explores the roles of the endothelial cell, glomerular basement membrane, and the podocyte and attempts to highlight examples of essential crosstalk within this barrier.

  9. Transforming growth factor-beta and the glomerular filtration barrier

    Directory of Open Access Journals (Sweden)

    Ayesha Ghayur

    2013-03-01

    Full Text Available The increasing burden of chronic kidney disease worldwide and recent advancements in the understanding of pathologic events leading to kidney injury have opened up new potential avenues for therapies to further diminish progression of kidney disease by targeting the glomerular filtration barrier and reducing proteinuria. The glomerular filtration barrier is affected by many different metabolic and immune-mediated injuries. Glomerular endothelial cells, the glomerular basement membrane, and podocytes—the three components of the filtration barrier—work together to prevent the loss of protein and at the same time allow passage of water and smaller molecules. Damage to any of the components of the filtration barrier can initiate proteinuria and renal fibrosis. Transforming growth factor-beta (TGF-β is a pleiotropic cytokine strongly associated with the fibrogenic response. It has a known role in tubulointerstitial fibrosis. In this review we will highlight what is known about TGF-β and how it interacts with the components of glomerular filtration barrier and causes loss of function and proteinuria.

  10. Simplified methods for assessment of renal function as the ratio of glomerular filtration rate to extracellular fluid volume

    DEFF Research Database (Denmark)

    Jødal, Lars; Brøchner-Mortensen, Jens

    2012-01-01

    Background: Instead of scaling glomerular filtration rate (GFR) to a body surface area of 1.73m2, it has been suggested to scale GFR to extracellular fluid volume (ECV). The ratio GFR/ECV has physiological meaning in that it indicates how often ‘that which is to be regulated’ (i.e. ECV) comes...... into contact with the ‘regulator’ (i.e. the kidneys). Aim: The aim of the present study was as follows: to analyse two published calculation methods for determining ECV and GFR/ECV; to develop a new simple and accurate formula for determining ECV; and to compare and evaluate these methods. Materials...... and methods: GFR was determined as 51Cr-EDTA clearance. The study comprised 128 individuals (35 women, 66 men and 27 children) with a full 51Cr-EDTA plasma concentration curve, determined from injection until 4–5 h p.i. Reference values for GFR and ECV were calculated from the full curve. One...

  11. Mechanism of reduced glomerular filtration rate in chronic malnutrition.

    Science.gov (United States)

    Ichikawa, I; Purkerson, M L; Klahr, S; Troy, J L; Martinez-Maldonado, M; Brenner, B M

    1980-05-01

    To determine the physiological basis for the low glomerular filtration rate in chronic malnutrition, micropuncture studies were performed in Munich-Wistar rats chronically pair-fed isocaloric diets of either low (group 1, nine rats) or high protein content (group 2, nine rats). Despite the absence of hypoalbuminemia, average values for single nephron and total kidney glomerular filtration rate were nearly 35% lower in group 1 than in group 2. Mean values for glomerular capillary and Bowman's space hydraulic pressures were essentially identical in the two groups, thereby excluding glomerular transcapillary hydraulic pressure difference as the cause for the low filtration rates in group 1 animals. On the other hand, average glomerular capillary plasma flow rate and glomerular capillary ultrafiltration coefficient were significantly lower (by approximately 25 and approximately 50%, respectively) in group 1 than in group 2. The fall in glomerular capillary plasma flow rate was the consequence of increased afferent and efferent arteriolar resistances. Plasma and erythrocyte volumes were found to be equal in five additional pairs of group 1 and group 2 rats. Thus, the substantial alterations in the ultrafiltration coefficient, glomerular capillary plasma flow rate, and renal arteriolar resistances responsible for the low filtration rate in group 1 animals were not merely a consequence of decreased circulating blood or plasma volumes. Mean values for glomerular cross sectional area were significantly lower in group 1 than in group 2 despite similar values for kidney weight in the two groups. This reduction in glomerular cross sectional area in group 1 rats is presumed to reflect a decrease in effective filtration surface area and therefore likely accounts, at least in part, for the decline in ultrafiltration coefficient observed in this group.Finally, since the daily caloric intake of group 2 animals was restricted because of pair feeding requirements tied to the group 1

  12. Comparison of measured glomerular filtration rates with isotope infusion and with the modification of diet in renal disease equation in cancer patients with raised serum creatinine

    Directory of Open Access Journals (Sweden)

    Amrah Javaid

    2015-01-01

    Full Text Available To compare the measured glomerular filtration rate (rGFR using [99mTc] diethylene triamine pentacetic acid (DTPA clearance or estimated GFR (eGFR by the Modification of Diet in Renal Disease (MDRD equation in cancer patients with raised serum creatinine level, we studied 100 cancer patients; 50 patients with normal serum creatinine (control group and 50 patients with abnormal serum creatinine (study group. History of patients, including site of cancer, chemotherapy regime and dose of chemotherapy, was recorded. The rGFR and eGFR were increased in the study group as compared with the control group, but the GFR recorded by the MDRD formula or DTPA revealed similar values. It is therefore concluded that the MDRD equation may be recommended for eGFR estimation even with abnormal creatinine, without the need for exposure to radiation.

  13. 肾动态显像测定肾小球滤过率%Application of renal dynamic imaging in the determination of glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    解朋; 李冬雪; 黄建敏

    2012-01-01

    测定肾小球滤过率(GFR)能够为评估肾脏病患者肾功能状态、观察治疗效果、调整治疗方案及判断预后等提供重要参考.肾动态显像测定GFR无创、操作简便、准确性高,并能评价分肾功能,因而广泛应用于临床.本文就目前肾动态显像测定GFR的现状做一综述.%As one of the most important index to evaluate the renal function, assess the treatment effectiveness, help to correct the treatment strategy and predict the prognosis, glomerular filtration rate (GFR) can be determined by several methods. Renal dynamic imaging possesses the advantage of non-invasive examination, easy operation, and high accuracy and the split renal function, therefore has been applied widely. The current status of GFR determined by renal dynamic imaging were reviewed in this article.

  14. Changes in glomerular filtration rate, lithium clearance and plasma protein clearances in the early phase after unilateral nephrectomy in living healthy renal transplant donors

    DEFF Research Database (Denmark)

    Strandgaard, S; Kamper, A; Skaarup, P;

    1988-01-01

    1. Glomerular and tubular function was studied before and 2 months after unilateral nephrectomy in 14 healthy kidney donors by measurement of the clearances of 51Cr-labelled ethylenediaminetetra-acetate, lithium, beta 2-microglobulin, albumin and immunoglobulin G. 2. The glomerular filtration rate...

  15. Clinical use of estimated glomerular filtration rate for evaluation of kidney function

    DEFF Research Database (Denmark)

    Broberg, Bo; Lindhardt, Morten; Rossing, Peter;

    2013-01-01

    Estimating glomerular filtration rate by the Modification of Diet in Renal Disease or Chronic Kidney Disease Epidemiology Collaboration formulas gives a reasonable estimate of kidney function for e.g. classification of chronic kidney disease. Additionally the estimated glomerular filtration rate...

  16. Glomerular filtration rate after alpha-radioimmunotherapy with 211At-MX35-F(ab')2: a long-term study of renal function in nude mice

    DEFF Research Database (Denmark)

    Back, T.; Haraldsson, B.; Hultborn, R;

    2009-01-01

    and animals bearing subcutaneous xenografts of the human ovarian cancer cell line, OVCAR-3, were used. The animals received approximately 0.4, 0.8, or 1.2 MBq in one, two, or three fractions. The mean absorbed doses to the kidneys ranged from 1.5 to 15 Gy. The renal function was studied by serial GFR...... of the glomerular filtration rate (GFR). The renal toxicity was evaluated at levels close to the dose limit for the bone marrow and well within the range for therapeutic efficacy on tumors. Astatinated MX35-F(ab')(2) monoclonal antibodies were administered intravenously to nude mice. Both non-tumor-bearing animals...... manifested late. Examination of the kidney sections showed histologic changes that were overall subdued. Following alpha-RIT with (211)At-MX35-F(ab')(2) at levels close to the dose limit of severe myelotoxicity, the effects found on renal function were relatively small, with only minor to moderate reductions...

  17. Sex differences in serum CK activity but not in glomerular filtration rate after resistance exercise: is there a sex dependent renal adaptative response?

    Science.gov (United States)

    Amorim, Mayra Z; Machado, Marco; Hackney, Anthony C; de Oliveira, Wilkes; Luz, Carla Patrícia Novais; Pereira, Rafael

    2014-01-01

    We investigated differences in sex responses in serum CK activity and renal function measured by glomerular filtration rate (GFR) after an exercise session. Twenty-two healthy and trained volunteers (11 males and 11 females) performed 17 resistance exercises with 3 × 12 repetitions in a circuit training fashion. Subjects provided blood samples prior to exercise session, and at 24, 48, and 72 h following exercise sessions for creatine kinase and creatinine. Twenty-four-hour urine samples were collected before and 72 h after the exercise. Estimate (e) GFR was obtained by using the Chronic Kidney Disease Epidemiology Collaboration equation adjusted for males and females. After the exercise session, males showed greater serum CK activity than females (p  0.05) between sex for serum and urinary creatinine. eGFR decreased significantly for males (~10 %) and females (~8 %), but also without a difference between the sexes (p > 0.05). The correlation between CK and eGFR was significant for males (r = -0.794; p = 0.003), and females (r = -0.8875; p < 0.001). A significant negative correlation between CK activity and the eGFR indice of renal function in both males and females was observed. Additionally, the renal function compromise was similar for both sexes, despite males presenting greater exercise-induced skeletal muscle damage when compared to females.

  18. Tamm-Horsfall protein regulates circulating and renal cytokines by affecting glomerular filtration rate and acting as a urinary cytokine trap.

    Science.gov (United States)

    Liu, Yan; El-Achkar, Tarek M; Wu, Xue-Ru

    2012-05-11

    Although few organ systems play a more important role than the kidneys in cytokine catabolism, the mechanism(s) regulating this pivotal physiological function and how its deficiency affects systemic cytokine homeostasis remain unclear. Here we show that elimination of Tamm-Horsfall protein (THP) expression from mouse kidneys caused a marked elevation of circulating IFN-γ, IL1α, TNF-α, IL6, CXCL1, and IL13. Accompanying this were enlarged spleens with prominent white-pulp macrophage infiltration. Lipopolysaccharide (LPS) exacerbated the increase of serum cytokines without a corresponding increase in their urinary excretion in THP knock-out (KO) mice. This, along with the rise of serum cystatin C and the reduced inulin and creatinine clearance from the circulation, suggested that diminished glomerular filtration may contribute to reduced cytokine clearance in THP KO mice both at the baseline and under stress. Unlike wild-type mice where renal and urinary cytokines formed specific in vivo complexes with THP, this "trapping" effect was absent in THP KO mice, thus explaining why cytokine signaling pathways were activated in renal epithelial cells in such mice. Our study provides new evidence implicating an important role of THP in influencing cytokine clearance and acting as a decoy receptor for urinary cytokines. Based on these and other data, we present a unifying model that underscores the role of THP as a major regulator of renal and systemic immunity.

  19. Inflammation and renal function after a four-year follow-up in subjects with unimpaired glomerular filtration rate: results from the observational, population-based CARLA cohort.

    Directory of Open Access Journals (Sweden)

    Daniel Medenwald

    Full Text Available There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood.To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population.After excluding subjects with reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2 and missing data, the cohort incorporated 785 men and 659 women (aged 45-83 years. Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1, C-reactive protein (CRP, and interleukin 6 (IL-6 with change in eGFR/creatinine. The areas under the curve (AUCs from receiver operating characteristics (ROCs were estimated.In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m2 per 100 pg/mL sTNF-R1; 95% CI: 0.4-0.8, but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine.In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.

  20. D-2-like receptor stimulation decreases effective renal plasma flow and glomerular filtration rate in spontaneously hypertensive rats

    NARCIS (Netherlands)

    de Vries, PAM; de Jong, PE; de Zeeuw, D; Navis, GJ

    2002-01-01

    In spontaneously hypertensive rats (SHRs) the dopaminergic D-1-like renal vasodilator response is impaired. The renal vascular response to D-2-like receptor stimulation in vivo is incompletely known. Therefore, renal hemodynamics were studied in conscious SHRs during continuous infusion of D-2-like

  1. Symptomatic hyponatremia during glomerular filtration rate testing

    OpenAIRE

    2010-01-01

    Hyponatremia affects nearly one in five of all hospitalized patients. Severe hyponatremia is associated with significant morbidity and mortality, and is therefore important to recognize. Prior reports have linked duloxetine with hyponatremia, but it is uncommon. In this case report, we describe a research subject taking duloxetine who developed severe symptomatic hyponatremia during glomerular filtration rate testing despite having undergone such testing uneventfully in the past.

  2. Controversies on glomerular filtration from Ludwig to the present.

    Science.gov (United States)

    Steinhausen, M; Endlich, K

    1996-01-01

    Since Ludwig's theory of filtration in the glomerulus is generally accepted, current research interest has focussed on the regulation of this process. The main determinants of glomerular filtration rate are glomerular capillary pressure and glomerular blood flow, which are adjusted via resistance changes in the pre- and postglomerular vasculature. Overall pre- and postglomerular resistances were first determined by micropuncture in superficial glomeruli. While the predominant source of postglomerular resistance is the efferent arteriole, several results indicate that preglomerular resistance might be rather uniformly distributed among all preglomerular vessels (interlobar, arcuate and interlobular arteries and afferent arterioles). Over the last decade, several techniques have been used to visualize renal vessels and to study the action of various vasoactive hormones thereon. Results obtained with the split hydronephrotic kidney model, which permits in vivo microscopy of all renal vessels, provide evidence for a differential regulation of the various preglomerular vessels by vasoactive hormones. In particular, mediators of inflammation almost selectively constrict interlobar and arcuate arteries. We conclude that, given the renal vascular architecture, differential regulation of preglomerular vessels can alter haemodynamic parameters specifically for different nephron populations.

  3. Impaired autoregulation of glomerular filtration rate in type 1 (insulin-dependent) diabetic patients with nephropathy

    DEFF Research Database (Denmark)

    Parving, H H; Kastrup, Helge; Smidt, U M;

    1984-01-01

    served as controls. Renal function was assessed by glomerular filtration rate (single bolus 51Cr-EDTA technique) and urinary albumin excretion rate (radial immunodiffusion). The study was performed twice within 2 weeks, with the subjects receiving an intravenous injection of either clonidine (225...... arterial blood pressure in all three groups (16-18 mmHg). While glomerular filtration rate and urinary albumin excretion rate remained unchanged in both control groups after clonidine injection, glomerular filtration rate diminished from 78 to 71 ml/min per 1.73 m2 (p les than 0.01), and urinary albumin...... excretion declined from 1707 to 938 micrograms/min (p less than 0.01) in the patients with diabetic nephropathy. Our results suggest that an intrinsic vascular (arteriolar) mechanism underlying the normal autoregulation of glomerular filtration rate, i.e. the relative constancy of glomerular filtration rate...

  4. Glomerular filtration rate and proteinuria: association with mortality and renal progression in a prospective cohort of a community-based elderly population.

    Directory of Open Access Journals (Sweden)

    Se Won Oh

    Full Text Available Limited prospective data are available on the importance of estimated glomerular filtration rate (GFR and proteinuria in the prediction of all-cause mortality (ACM in community-based elderly populations. We examined the relationship between GFR or proteinuria and ACM in 949 randomly selected community-dwelling elderly subjects (aged ≥65 years over a 5-year period. A spot urine sample was used to measure proteinuria by the dipstick test, and GFR was estimated using the chronic kidney disease-epidemiology collaboration (CKD-EPI equation. Information about mortality and causes of death was collected by direct enquiry with the subjects and from the national mortality data. Compared to subjects without proteinuria, those with proteinuria of grade ≥1+ had a 1.725-fold (1.134-2.625 higher risk of ACM. Compared to subjects with GFR ≥90 ml/min/1.73 m2, those with GFR<45 ml/min/1.73 m2 had a 2.357 -fold (1.170-4.750 higher risk for ACM. Among the 403 subjects included in the analysis of renal progression, the annual rate of GFR change during follow-up period was -0.52±2.35 ml/min/1.73 m2/year. The renal progression rate was 7.315-fold (1.841-29.071 higher in subjects with GFR<60 ml/min/1.73 m2 than in those with GFR ≥60 ml/min/1.73 m2. Among a community-dwelling elderly Korean population, decreased GFR of <45 ml/min/1.73 m2 and proteinuria were independent risk factors for ACM.

  5. Comparison of glomerular filtration rate by renal dynamic imaging method and double plasma method%肾动态显像法与双血浆法测定肾小球滤过率的比较

    Institute of Scientific and Technical Information of China (English)

    廖曼甜

    2014-01-01

    Objective To study differences of glomerular filtration rate measured by renal dynamic imaging method and double plasma method. Methods All 108 cases of kidney disease patients received Gates radionuclide renal dynamic imaging by renal dynamic imaging to get the glomerular filtration rate, then implemented intravenous injection of 99mTc-DTPA, blood were collected at two time periods(2 h, 4 h), radioactive material was calculated in 1 ml of plasma, calculated glomerular filtration rate using double plasma method, adopted double plasma method to calculate the glomerular filtration rate, finally analyzed determination results of renal dynamic imaging method and dual plasma method. Results The average was 49.76 with renal dynamic imaging method, while 45.39 with double plasma method, the difference was not statistically significant(P>0.05). Conclusion No significant correlation was found between the two methods for detection results, but the detection of renal dynamic imaging method index is comprehensive, combination of two methods should be used for the determination of glomerular filtration rate.%目的:研究肾动态显像法以及双血浆法共同测定肾小球滤过率的差异。方法108例肾脏病患者,利用肾动态显像完成Gates法核素肾动态显像,得到肾小球滤过率,然后实施静脉注射99 m锝-二乙三胺五乙酸(Tc-DTPA),分2 h和4 h两个时间段采集患者血液,统计1 ml血浆中的放射性物质,采用双血浆法计算得到肾小球滤过率,最后就肾动态显像法以及双血浆法的测定结果进行分析。结果肾动态显像法测定的平均值为49.76,而双血浆测定平均值为45.39,差异无统计学意义( P>0.05)。结论两种检测方法无明显的相关性,但肾动态显像法检测的指标较为全面,在临床上可选择将两者联合检测肾小球滤过率。

  6. Recombinant human erythropoietin in humans down-regulates proximal renal tubular reabsorption and causes a fall in glomerular filtration rate

    DEFF Research Database (Denmark)

    Olsen, Niels Vidiendal; Aachmann-Andersen, Niels Jacob; Oturai, Peter;

    2010-01-01

    rHuEPO elevates hemoglobin concentration both by increasing red blood cell volume and by a decrease in plasma volume. This study delineates the association of rHuEPO-induced changes in blood volumes with changes in the renin-aldosterone system and renal function. 16 healthy males were given rHuEPO...... tubular outflow and to assess segmental renal tubular handling of sodium and water. rHuEPO-induced increases in hematocrit occurred from day 10 onwards and was caused by both an increase in red cell volume and a fall in plasma volume. Well before that (from day 2 and throughout the treatment time), rHuEPO...... decreased plasma levels of renin and aldosterone (N = 8) by 21 - 33 % (P EPO values returned to baseline. On days 11 and 29 C(Li) increased (P

  7. Creatinine clearance as a substitute for the glomerular filtration rate in the assessment of glomerular hemodynamics.

    Science.gov (United States)

    Okada, N; Imanishi, M; Yoshioka, K; Konishi, Y; Okumura, M; Tanaka, S; Fujii, S

    1999-11-01

    A method for the clinical assessment of glomerular hemodynamics has been published previously. We here examined whether, when using this method, renal creatinine clearance (Ccr) can be substituted for the glomerular filtration rate (GFR). The study subjects comprised 57 inpatients from Osaka City General Hospital: 30 with type 2 diabetes mellitus and 27 with chronic glomerulonephritis. During the 2-wk study, patients received a high-salt diet for 1 wk and a low-salt diet for 1 wk. Urinary sodium excretion and systemic blood pressure were measured daily. The renal plasma flow, Ccr, and plasma total protein concentration were also evaluated simultaneously on the last day of the high-salt diet. The GFR was also calculated from the fractional renal accumulation of 99mTc-diethylenetriaminepentaacetic acid (DTPA). Glomerular hemodynamics, represented by the glomerular capillary hydraulic pressure and the resistance of afferent and efferent arterioles, were calculated using the renal clearance, the plasma total protein concentration, and the pressure-natriuresis relationship. Values for renal hemodynamics with the Ccr-derived GFR were compared with those from the 99mTc-DTPA-derived GFR. Ccr values of 53 to 169 ml/min correlated with the 99mTc-DTPA-derived clearance of 39 to 179 ml/min (n=57, r=.71, presistances of afferent and efferent arterioles calculated using the Ccr-derived GFR correlated significantly with those calculated using the 99mTc-DTPA-derived GFR (r=.99, p<.001 and r=.99, p<.001, respectively). These results indicate that the Ccr is an accurate representation of the GFR for use in glomerular hemodynamic analysis of the pressure-natriuresis relationship.

  8. Importance of glomerular filtration rate change as surrogate endpoint for the future incidence of end-stage renal disease in general Japanese population: community-based cohort study.

    Science.gov (United States)

    Kanda, Eiichiro; Usui, Tomoko; Kashihara, Naoki; Iseki, Chiho; Iseki, Kunitoshi; Nangaku, Masaomi

    2017-09-07

    Because of the necessity for extended period and large costs until the event occurs, surrogate endpoints are indispensable for implementation of clinical studies to improve chronic kidney disease (CKD) patients' prognosis. Subjects with serum creatinine level for a baseline period over 1-3 years were enrolled (n = 69,238) in this community-based prospective cohort study in Okinawa, Japan, and followed up for 15 years. The endpoint was end-stage renal disease (ESRD). The percent of estimated glomerular filtration rate (%eGFR) change was calculated on the basis of the baseline period. Subjects had a mean ± SD age, 55.59 ± 14.69 years; eGFR, 80.15 ± 21.15 ml/min/1.73 m(2). Among the subjects recruited, 15.81% had a low eGFR (changes over 2 or 3 years in the high- and low-eGFR groups. The specificities and positive predictive values for ESRD based on a cutoff value of %eGFR change of less than -30% over 2 or 3 years were high in the high- and low-eGFR groups. %eGFR change tends to be associated with the risk of ESRD. %eGFR change of less than -30% over 2 or 3 years can be a candidate surrogate endpoint for ESRD in the general Japanese population.

  9. Vitamin D status in renal transplant recipients living in a low-latitude city: association with body fat, cardiovascular risk factors, estimated glomerular filtration rate and proteinuria.

    Science.gov (United States)

    Rosina, Kelli T C; Menna Barreto, Ana Paula M; Pontes, Karine S S; Martins, Cyro J M; Souza, Edison; Bregman, Rachel; Barreto Silva, Maria Inês; Klein, Márcia R S T

    2017-05-01

    Recent evidence suggests that vitamin D deficiency is associated with CVD, impaired kidney function and proteinuria. To date, no study has evaluated these associations in renal transplant recipients (RTR) adjusting for body adiposity assessed by a 'gold standard' method. This study aimed to evaluate the vitamin D status and its association with body adiposity, CVD risk factors, estimated glomerular filtration rate (eGFR) and proteinuria in RTR, living in Rio de Janeiro, Brazil (a low-latitude city (22°54'10"S)), taking into account body adiposity evaluated by dual-energy X-ray absorptiometry (DXA). This cross-sectional study included 195 RTR (114 men) aged 47·6 (sd 11·2) years. Nutritional evaluation included anthropometry and DXA. Risk factors for CVD were hypertension, diabetes mellitus, dyslipidaemia and the metabolic syndrome. eGFR was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation. Serum 25-hydroxyvitamin D (25(OH)D) concentration was used to define vitamin D status as follows: 10 % (n 19) had vitamin D deficiency (30 ng/ml). Percentage of body fat (DXA) was significantly associated with vitamin D deficiency independently of age, sex and eGFR. Lower 25(OH)D was associated with higher odds of the metabolic syndrome and dyslipidaemia after adjustment for age, sex and eGFR, but not after additional adjustment for body fat. Hypertension and diabetes were not related to 25(OH)D. Lower serum 25(OH)D was associated with increasing proteinuria and decreasing eGFR even after adjustments for age, sex and percentage of body fat. This study suggests that in RTR of a low-latitude city hypovitaminosis D is common, and is associated with excessive body fat, decreased eGFR and increased proteinuria.

  10. Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Utsunomiya, Daisuke; Yanaga, Yumi; Oda, Seitaro; Namimoto, Tomohiro; Yamashita, Yasuyuki (Dept. of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan)), email: utsunomi@kumamoto-u.ac.jp; Awai, Kazuo (Dept. of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima Univ., Hiroshima (Japan)); Funama, Yoshinori (Dept. of Medical Physics, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan))

    2011-06-15

    Background Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. Purpose To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. Material and Methods A total of 6586 patients (3630 men and 2956 women; mean age 57.0 +- 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m2) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 < =eGFR < 90, 45 < =eGFR < 60, 30 < =eGFR < 45 and eGFR < 30, respectively. Results Of the 6586 patients, 1.6%, 3.7%, 13.7%, and 54.2% were judged to present with severe, moderate-b, moderate-a, and mild RI, respectively. While moderate-b-to-severe RI was recorded in 133 (3.2%) of 4161 patients aged 70 years or less, it was observed in 218 (9.0%) of the 2425 patients who were 71 years or older. Among the 829 CVD patients, 9.9% manifested moderate-b-to-severe- and 73.0% mild-to-moderate-a RI. The corresponding rates were 4.4% and 68.9% for oncologic disease, 16.9% and 61.2% for DM, and 4.8% and 71.5% for CLD patients. By univariate analysis, there was a significant association between moderate-b-to-severe RI and the advanced age, CVD, DM, and non-oncologic disease. Multivariate analysis showed that the advanced age, DM, and non-oncologic disease were statistically associated with moderate-b-to-severe RI. Conclusion The incidence of RI of eGFR < 45mL/min/1.73 m2 at baseline was high in patients with advanced age, CVD and DM and

  11. Individualizing pharmacotherapy in patients with renal impairment: the validity of the Modification of Diet in Renal Disease formula in specific patient populations with a glomerular filtration rate below 60 ml/min. A systematic review.

    Directory of Open Access Journals (Sweden)

    Willemijn L Eppenga

    Full Text Available The Modification of Diet in Renal Disease (MDRD formula is widely used in clinical practice to assess the correct drug dose. This formula is based on serum creatinine levels which might be influenced by chronic diseases itself or the effects of the chronic diseases. We conducted a systematic review to determine the validity of the MDRD formula in specific patient populations with renal impairment: elderly, hospitalized and obese patients, patients with cardiovascular disease, cancer, chronic respiratory diseases, diabetes mellitus, liver cirrhosis and human immunodeficiency virus.We searched for articles in Pubmed published from January 1999 through January 2014. Selection criteria were (1 patients with a glomerular filtration rate (GFR < 60 ml/min (/1.73 m2, (2 MDRD formula compared with a gold standard and (3 statistical analysis focused on bias, precision and/or accuracy. Data extraction was done by the first author and checked by a second author. A bias of 20% or less, a precision of 30% or less and an accuracy expressed as P30% of 80% or higher were indicators of the validity of the MDRD formula. In total we included 27 studies. The number of patients included ranged from 8 to 1831. The gold standard and measurement method used varied across the studies. For none of the specific patient populations the studies provided sufficient evidence of validity of the MDRD formula regarding the three parameters. For patients with diabetes mellitus and liver cirrhosis, hospitalized patients and elderly with moderate to severe renal impairment we concluded that the MDRD formula is not valid. Limitations of the review are the lack of considering the method of measuring serum creatinine levels and the type of gold standard used.In several specific patient populations with renal impairment the use of the MDRD formula is not valid or has uncertain validity.

  12. Estimating Glomerular Filtration Rate in Older People

    Directory of Open Access Journals (Sweden)

    Sabrina Garasto

    2014-01-01

    Full Text Available We aimed at reviewing age-related changes in kidney structure and function, methods for estimating kidney function, and impact of reduced kidney function on geriatric outcomes, as well as the reliability and applicability of equations for estimating glomerular filtration rate (eGFR in older patients. CKD is associated with different comorbidities and adverse outcomes such as disability and premature death in older populations. Creatinine clearance and other methods for estimating kidney function are not easy to apply in older subjects. Thus, an accurate and reliable method for calculating eGFR would be highly desirable for early detection and management of CKD in this vulnerable population. Equations based on serum creatinine, age, race, and gender have been widely used. However, these equations have their own limitations, and no equation seems better than the other ones in older people. New equations specifically developed for use in older populations, especially those based on serum cystatin C, hold promises. However, further studies are needed to definitely accept them as the reference method to estimate kidney function in older patients in the clinical setting.

  13. Effect of lithium therapy on glomerular filtration rate.

    Science.gov (United States)

    Decina, P; Oliver, J A; Sciacca, R R; Colt, E; Fieve, R R

    1983-08-01

    Patients taking lithium had a slightly higher serum creatinine concentration than controls. Creatinine concentration was independent of lithium level or therapy length, suggesting that lithium decreases glomerular filtration but that this effect is small, noncumulative, and of marginal clinical significance.

  14. Glomerular filtration rate in cows estimated by a prediction formula.

    Science.gov (United States)

    Murayama, Isao; Miyano, Anna; Sato, Tsubasa; Iwama, Ryosuke; Satoh, Hiroshi; Ichijyo, Toshihiro; Sato, Shigeru; Furuhama, Kazuhisa

    2014-12-01

    To testify the relevance of Jacobsson's equation for estimating bovine glomerular filtration rate (GFR), we prepared an integrated formula based on its equation using clinically healthy dairy (n=99) and beef (n=63) cows, and cows with reduced renal function (n=15). The isotonic, nonionic, contrast medium iodixanol was utilized as a test tracer. The GFR values estimated from the integrated formula were well consistent with those from the standard multisample method in each cow strain, and the Holstein equation prepared by a single blood sample in Holstein dairy cows. The basal reference GFR value in healthy dairy cows was significantly higher than that in healthy beef cows, presumably due to a breed difference or physiological state difference. It is concluded that the validity for the application of Jacobsson's equation to estimate bovine GFR is proven and it can be used in bovine practices.

  15. Relationship between islet α-cell function and glomerular filtration rate in type 2 diabetic patients

    Institute of Scientific and Technical Information of China (English)

    王晓宇

    2013-01-01

    Objective To analyze the isletα-cell function in type 2 diabetic patients with different levels of glomerular filtration rate (eGFR) .Methods Three hundred and eighty-eight cases of type 2 diabetic patients were classified into four groups according to eGFR:glomerular hyperfiltration group,normal renal function group,mild renal dysfunction group and moderate-severe renal dysfunction group.Oral glucose tolerance test,insulin releasing test and glucagon releasing test were conducted to compare

  16. The correlation between effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) with renal scintigraphy 99mTc-DTPA study

    Science.gov (United States)

    Ratnasari, D.; Nazir, F.; Toresano, L. O. H. Z.; Pawiro, S. A.; Soejoko, D. S.

    2016-03-01

    The prevalence of chronic renal diseases in Indonesia has an increasing annual trend, because it is frequently unrecognized and often co-exists with other disease. GFR and ERPF are parameters currently utilized to estimate renal function at routine renal scintigraphy 99m-Tc DTPA study. This study used 99m-Tc DTPA to measure GFR and ERPF. The purpose of this study was to find the correlation between ERPF and GFR, for ERPF analysis with Schlegel's method, and GFR analysis with Gate's method, as well as to find correction factor between both variables. Analysis of renal scintigraphy has been performed at Department of Nuclear Medicine Pertamina Center Hospital to thirty patient images acquired from 2014 to 2015 which were analyzed retrospectively data, using gamma camera dual head with counting method from renal scintigraphy 99m-Tc DTPA study. The calculation was executed by means of both display and manual calculation. Pearson's statistical analysis resulted on Positive Correlation for all data, with ERPF and GFR (display) showing Strongly Positive Correlation (r = 0.82; p- value < 0.05). Standard deviation was found to be 27.58 and 107.64 for GFR and ERPF (display), respectively. Our result indicated that the use of 99mTc-DTPA measure ERPF was not recommended.

  17. Estimation of single-kidney glomerular filtration rate without exogenous contrast agent.

    Science.gov (United States)

    He, Xiang; Aghayev, Ayaz; Gumus, Serter; Ty Bae, K

    2014-01-01

    Measurement of single-kidney filtration fraction and glomerular filtration rate (GFR) without exogenous contrast is clinically important to assess renal function and pathophysiology, especially for patients with comprised renal function. The objective of this study is to develop a novel MR-based tool for noninvasive quantification of renal function using conventional MR arterial spin labeling water as endogenous tracer. The regional differentiation of the arterial spin labeling water between the glomerular capsular space and the renal parenchyma was characterized and measured according to their MR relaxation properties (T1ρ or T2 ), and applied to the estimation of filtration fraction and single-kidney GFR. The proposed approach was tested to quantify GFR in healthy volunteers at baseline and after a protein-loading challenge. Biexponential decay of the cortical arterial spin labeling water MR signal was observed. The major component decays the same as parenchyma water; the minor component decays much slower as expected from glomerular ultra-filtrates. The mean single-kidney GFR was estimated to be 49 ± 9 mL/min at baseline and increased by 28% after a protein-loading challenge. We developed an arterial spin labeling-based MR imaging method that allows us to estimate renal filtration fraction and singe-kidney GFR without use of exogenous contrast. Copyright © 2013 Wiley Periodicals, Inc.

  18. Hemodinâmica glomerular renal no roedor Calomys callosus

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    Mirian A. Boim

    1989-03-01

    Full Text Available A função renal do roedor Calomys callosus, envolvido no ciclo de transmissão de diversos agentes patogênicos para o homem foi avaliada no animal intacto, através da técnica de depuração e micropunção renal. Os resultados mostraram que este roedor apresenta níveis pressóricos, hematócrito e proteinas plasmáticas semelhantes aos dos ratos submetidos ao mesmo procedimento experimental. Os pesos corporal e renal, bem como a filtração glomerular global e por nefro assemelham-se aos do camundongo. Surpreendentemente estes roedores apresentaram significante número de glomérulos superficiais por rim, permitindo a avaliação da hemodinàmica glomerular. Apesar da pressão arterial semelhante à dos ratos Munich-Wistar (MW, a pressão hidráulica intraglomerular no Calomys callosus foi inferior. Esta redução foi conseqüente à menor resistência pós-glomerular quando comparada à dos ratos MW. O fluxo plasmático glomerular atingiu valor bastante elevado em relação à filtração glomerular por nefro, fato que não só compensaria a reduzida pressão intraglomerular, como também seria suficiente para elevar a filtração (por g/rim a níveis superiores neste roedor, pois o coeficiente de ultrafiltração glomerular (Kj foi semelhante ao do rato MW. O presente trabalho sugere que apesar das dificuldades técnicas que este animal impõe devido ao seu reduzido tamanho, o estudo da função renal global bem como da hemodinàmica glomerular é factível, podendo portanto ser utilizado como modelo para estudo da função renal em doenças tropicais.Renal function was characterized in Calomys callosus, a rodent which can participate in the transmission of several human diseases. The results showed that the pressures levels, hematocrit and plasmatic proteins were similar to rats submitted to the same experimental maneuvers. The corporal and renal weights, whole and single nephron glomerular filtration rates were similar to the mouse

  19. Impaired autoregulation of the glomerular filtration rate in patients with nondiabetic nephropathies

    DEFF Research Database (Denmark)

    Christensen, P K; Hommel, E E; Clausen, P

    1999-01-01

    BACKGROUND: The ability of the kidney to maintain constancy of the glomerular filtration rate (GFR) over a wide range of renal perfusion pressures is termed autoregulation. Defective autoregulation of GFR has been demonstrated in diabetic nephropathy. Whether this is also the case in patients...

  20. Rapid decline in glomerular filtration rate during the first weeks following heart transplantation

    DEFF Research Database (Denmark)

    Hornum, M; Andersen, Mads Jønsson; Gustafsson, F

    2011-01-01

    We hypothesized that a decrease in renal function is seen immediately after heart transplantation (HTX) with little recovery over time. Twelve consecutive patients had their glomerular filtration rate (GFR) measured using (51)Cr-ethylenediaminetetraacetic acid (EDTA) measured GFR (mGFR) before tr...

  1. Review series: The cell biology of renal filtration.

    Science.gov (United States)

    Scott, Rizaldy P; Quaggin, Susan E

    2015-04-27

    The function of the kidney, filtering blood and concentrating metabolic waste into urine, takes place in an intricate and functionally elegant structure called the renal glomerulus. Normal glomerular function retains circulating cells and valuable macromolecular components of plasma in blood, resulting in urine with just trace amounts of proteins. Endothelial cells of glomerular capillaries, the podocytes wrapped around them, and the fused extracellular matrix these cells form altogether comprise the glomerular filtration barrier, a dynamic and highly selective filter that sieves on the basis of molecular size and electrical charge. Current understanding of the structural organization and the cellular and molecular basis of renal filtration draws from studies of human glomerular diseases and animal models of glomerular dysfunction.

  2. /sup 125/I iothalamate an ideal marker for glomerular filtration

    Energy Technology Data Exchange (ETDEWEB)

    Odlind, B.; Haellgren, R.S.; Sohtell, M.; Lindstroem, B.

    1985-01-01

    The triiodinated angiographic contrast medium, iothalamate (usually labelled /sup 125/I), has been used extensively as a marker for glomerular filtration. The authors have studied the renal handling of /sup 125/I iothalamate (IOT) in vivo and in vitro in several species. In renal cortical slices from chicken, rabbit, rat, and monkey, the tissue-to-medium ratio of IOT was twice that of /sup 51/Cr-EDTA (EDTA) at 37 degrees C; a difference that was abolished at 0 degree C and markedly reduced by added o-iodohippurate or iodipamide. In five chickens the steady-state renal clearance of IOT (CIOT) was twice that of EDTA (CEDTA) or /sup 3/H inulin (C1); a difference that was abolished by administration of 100 mg/kg/hr of novobiocin, an organic anion transport inhibitor. CEDTA was similar to C1 before as well as after transport inhibition. Utilizing the Sperber technique the mean apparent tubular excretion fraction (ATEF) of IOT was 8%, while that of EDTA was 1%. After novobiocin coinfusion (new steady-state) ATEFIOT was significantly reduced and not different from that of EDTA (-1%). In the same animals the total urinary recovery of IOT was 84 and 57% before and after novobiocin, respectively, while corresponding values for EDTA was unchanged by the inhibitor. In seven rats the renal extraction of IOT was reduced from 29 to 17% by coinfusion of probenecid (5 mg/kg/hr). Corresponding extractions were 82 to 34% and 22% (unchanged) for PAH and EDTA, respectively.

  3. Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.

    Directory of Open Access Journals (Sweden)

    Elisabet Zamora

    Full Text Available BACKGROUND: To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis. METHODOLOGY/PRINCIPAL FINDINGS: A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75 60.5-77.2] were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%. The left ventricular ejection fraction was 34% (P(25-75 26-43%. Most patients were New York Heart Association class II (65.8% or III (25.9%. During a median follow-up of 3.46 years (P(25-75 1.85-5.05, 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively. In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006 and 1.14 (95% CI: 1.02-1.28, P = 0.02 for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively. The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2, chi-square 12.9, P<0.001. CONCLUSIONS/SIGNIFICANCE: Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to

  4. Glomerular filtration rate is altered in children with sickle cell disease: a comparison between Hb SS and Hb SC

    Science.gov (United States)

    de Paula, Rafael Pereira; Nascimento, Alana Ferreira; Sousa, Sandra Mara Bispo; Bastos, Paulo Roberto Velasco; Barbosa, Ana Angélica Leal

    2013-01-01

    Background Renal failure is common among older patients with sickle cell disease; this is preceded by subclinical glomerular hyperfiltration. Data about renal function of adults with sickle cell disease have been reported, but data on children is scarce, especially when comparing heterozygotic and homozygotic patients. Objective The goal of this study was to investigate the glomerular filtration rate of heterozygotic and homozygotic children with sickle cell disease. Methods The glomerular filtration rate of 11 children with sickle cell disease [7 homozygotic (SS) and 4 heterozygotic (SC)] with a mean age of 11 years (standard deviation: ± 5 years) was evaluated using standard laboratory techniques. Results are presented as descriptive analysis. Results Our results suggest that glomerular hyperfiltration is present in children with sickle cell disease; this is more evident in homozygotic than heterozygotic children. Conclusion There is evidence of a need to monitor the renal function of children with sickle cell disease when special attention should be paid to homozygotic patients. PMID:24255619

  5. Measurement of glomerular filtration rate in the conscious rat.

    Science.gov (United States)

    Pestel, Sabine; Krzykalla, Volker; Weckesser, Gerhard

    2007-01-01

    Glomerular filtration rate (GFR) is an important parameter for studying drug-induced impairments on renal function in rats. The GFR is calculated from the concentration of creatinine and blood urea nitrogen (BUN) in serum and in urine, respectively. Following current protocols serum and urine samples must be taken from the same animal. Thus, in order to determine time-dependent effects it is necessary to use for each time point one separated group of animals. We developed a statistical test which allows analyzing the GFR from two different groups of animals: one used for repeated serum and the other one used for repeated urine analysis. Serum and urine samples were taken from two different sets of rats which were otherwise treated identically, i.e. drug doses, routes of administration (per os or per inhalation) and tap water loading. For each dose group GFR mean, standard deviation and statistical analysis to identify differences between the dose groups were determined. After determination of the optimal time points for measurements, the effect on GFR of the three reference compounds, furosemide, hydrochlorothiazide and formoterol, was calculated. The results showed that the diuretic drugs furosemide and hydrochlorothiazide decreased the GFR and the antidiuretic drug formoterol increased the GFR, as counter regulation on urine loss or urine retention, respectively. A mathematical model and the corresponding algorithm were developed, which can be used to calculate the GFR, and to test for differences between groups from two separated sets of rats, one used for urine, and the other one for serum analysis. This new method has the potential to reduce the number of animals needed and to improve the quality of data generated from various groups of animals in renal function studies.

  6. Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Yoshimi Iwasaki; Tokihiko Sawada; Shozo Mori; Yukihiro Iso; Masato Katoh; Kyu Rokkaku; Junji Kita; Mitsugi Shimoda; Keiichi Kubota

    2009-01-01

    AIM: To compare creatinine clearance (Ccr) with estimated glomerular filtration rate (eGFR) in preoperative renal function tests in patients undergoing hepatectomy. METHODS: The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied, and preoperative Ccr, a three-variable equation for eGFR (eGFR3) and a five-variable equation for eGFR (eGFR5) were calculated. Abnormal values were defined as Ccr < 50 mL/min, eGFR3 and eGFR5 < 60 mL/min per 1.73 m2. The maximum increases in the postoperative serum creatinine (post Cr) level and postoperative rate of increase in the serum Cr level (post Cr rate) were compared. RESULTS: There were 37 patients (18.8%) withabnormal Ccr, 31 (15.7%) with abnormal eGFR3, and 40 (20.3%) with abnormal eGFR5. Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr, eGFR3 and eGFR5 values, the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients ( P < 0.0001). Post Cr level tended to be higher in patients with Ccr abnormality ( P = 0.0936 and P = 0.0875, respectively). CONCLUSION: eGFR5 and the simpler eGFR3, rather than Ccr, are recommended as a preoperative renal function test in patients undergoing hepatectomy.

  7. Impact of creatinine production on the agreement between glomerular filtration rate estimates using cystatin C-derived, and 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations

    Science.gov (United States)

    Hermida-Cadahia, Esperanza F.; Lampon, Natalia

    2012-01-01

    Background. It has recently been reported that patient selection has a strong impact on the agreement between glomerular filtration rate (GFR) estimates from serum cystatin C and creatinine. The aim of our study was to evaluate the effect of creatinine production rate (CPR) on this subject. Material and methods. GFR was estimated from serum cystatin C and from creatinine using the 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 50 healthy subjects, 43 patients with renal failure, 794 kidney and 104 liver transplant recipients, 61 patients with heart failure, 59 patients with biliary obstruction, and 113 critically ill patients. Results. In the 295 patients with impaired CPR ( 900 mg/24 h/1.73 m2), greater discordances than 40% between GFRMDRD4 and GFRcystatinC were observed in 8% of cases, between GFRMDRD6 and GFRcystatinC in 9%, and between GFRCKD-EPI and GFRcystatinC in 7% (in the major part of cases due to GFR overestimation from cystatin C). Conclusion. The main source of differences of more than 40% between GFR estimates from serum creatinine and cystatin C is a GFR overestimation in patients with low CPR and GFR underestimation in patients with high CPR by the creatinine-derived equations. PMID:22746300

  8. The glomerular filtration rate during pregnancy : Saline infusion enhances the glomerular filtration rate in the pregnant rat

    NARCIS (Netherlands)

    Faas, MM; Schuiling, GA; Klok, PA; Valkhof, N; Bakker, WW

    1996-01-01

    The glomerular filtration rate (GFR) of pregnant rats is generally believed to exceed non-pregnant values. This notion is primarily based upon standard inulin clearances. However, the inulin clearance requires continuous infusion of inulin usually dissolved in saline. Since saline infusion per se in

  9. New normal values not related to age and sex, of glomerular filtration rate by (99m)Tc-DTPA renal dynamic imaging, for the evaluation of living kidney graft donors.

    Science.gov (United States)

    Zhao, Xiuyi; Shao, Yahui; Wang, Yanming; Tian, Jun; Sun, Ben; Ru, Yanhui; Zhang, Aimin; Hao, Junwen

    2012-01-01

    The aim of this study was to investigate the normal values of glomerular filtration rate (GFR) by technetium-99m diaethylene-triamine-pentaacetic acid ((99m)Tc-DTPA) renal dynamic imaging for living kidney graft donors. In a total of 212 candidate donors, GFR was examined using (99m)Tc-DTPA renal dynamic imaging. Donors with GFR≥80mL/(min×1.73m(2)) and as low as with GFR≥70mL/(min×1.73m(2)) but a normal endogenous creatinine clearance rate (CCr) were quantified for living kidney donation. Differences in GFR levels based on sex and age were analyzed using rank correlation coefficient. Out of the 212 candidates, 161 were finally selected as kidney graft donors. The double kidney total GFR between the male and female donor groups, the GFR levels among differently-aged donor groups, and the GFR levels between the elderly (>55 years) and young- and middle-aged (≤55 years) donor groups did not show any significant difference (P>0.05). After kidney donation, renal function measured by blood urea nitrogen (BUN) and serum creatinine of all donors returned to normal within one week, and no serious complications were noticed. In conclusion, renal dynamic imaging by (99m)Tc-DTPA had a good accuracy and repeatability in GFR evaluation for living kidney donors. Candidate donors with GFR between 70mL/(min×1.73m(2)) and 80mL/(min×1.73m(2)) can be selected as kidney donors after strict screening. In living kidney donors GFR is not significantly correlated with age or sex.

  10. RENAL RESERVE FILTRATION CAPACITY IN GROWTH-HORMONE DEFICIENT SUBJECTS

    NARCIS (Netherlands)

    DULLAART, RPF; MEIJER, S; MARBACH, P; SLUITER, WJ

    In normal subjects, the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) acutely increase in response to infusion of amino acids and to low doses of dopamine. It is uncertain whether circulatory growth hormone (GH) is a permissive factor for these stimulatory effects. GFR and

  11. Automatic Reporting of Creatinine-Based Estimated Glomerular Filtration Rate in Children: Is this Feasible?

    Directory of Open Access Journals (Sweden)

    Andrew Lunn

    2016-07-01

    Full Text Available Creatinine, although widely used as a biomarker to measure renal function, has long been known as an insensitive marker of renal impairment. Patients with reduced renal function can have a creatinine level within the normal range, with a rapid rise when renal function is significantly reduced. As of 1976, the correlation between height, the reciprocal of creatinine, and measured glomerular filtration rate (GFR in children has been described. It has been used to derive a simple formula for estimated glomerular filtration rate (eGFR that could be used at the bedside as a more sensitive method of identifying children with renal impairment. Formulae based on this association, with modifications over time as creatinine assay methods have changed, are still widely used clinically at the bedside and in research studies to assess the degree of renal impairment in children. Adult practice has moved in many countries to computer-generated results that report eGFR alongside creatinine results using more complex, but potentially more accurate estimates of GFR, which are independent of height. This permits early identification of patients with chronic kidney disease. This review assesses the feasibility of automated reporting of eGFR and the advantages and disadvantages of this in children.

  12. Maternal glomerular filtration rate in pregnancy and fetal size.

    Directory of Open Access Journals (Sweden)

    Nils-Halvdan Morken

    Full Text Available BACKGROUND: The relationship of maternal glomerular filtration rate (GFR in pregnancy to fetal size needs to be better characterized as it impacts an ongoing debate about confounding effect of maternal GFR in investigations of important environmental contaminants. We aimed to characterize the size of the association between maternal GFR and infant birth weight. MATERIALS AND METHODS: A sub-cohort of 953 selected women (470 women with and 483 women without preeclampsia in the Norwegian Mother and Child Cohort (MoBa, recruited during 2003-2007 were analyzed. GFR in the second trimester was estimated based on plasma creatinine. Birth weight was ascertained from the Medical Birth Registry of Norway. Multivariate linear regression was used to evaluate the association between maternal GFR in second trimester (estimated by the Cockroft-Gault [GFR-CG] and the modification of diet in renal disease [GFR-MDRD] formulas and infant birth weight. Partial correlation coefficients were also calculated. RESULTS: Maternal GFR-CG (β: 0.73 g/ml/min, p = 0.04 and GFR-MDRD (β: 0.83 g/ml/min, p = 0.04 were associated with infant birth weight in models adjusted for maternal weight in kilograms, preeclampsia, and gestational age at delivery (days. Partial correlation coefficients for the association between infant birth weight and GFR were 0.07 for both formulas. Although the birth weight-GFR association was stronger among the women with preeclampsia, the difference from women without preeclampsia was not statistically significant. CONCLUSION: These data support an association between GFR during pregnancy and infant birth weight, and indicate that GFR may confound selected epidemiologic associations.

  13. Exendin-4, but not glucagon-like peptide-1, is cleared exclusively by glomerular filtration in anaesthetised pigs

    DEFF Research Database (Denmark)

    Simonsen, L; Holst, Jens Juul; Deacon, C F

    2006-01-01

    /min), exceeded the amount which could be accounted for by glomerular filtration (4.2+/-0.5 pmol/min, presistance to enzymatic degradation, the increased stability of exendin-4 is the result of reduced differential organ extraction compared to GLP.......0+/-7.8%), whereas organ extraction of exendin-4 was limited to the kidneys (21.3+/-4.9%). While the renal extraction of exendin-4 (6.9+/-2.5 pmol/min) did not differ significantly from the amount undergoing glomerular filtration (8.4+/-2.0 pmol/min), the renal extraction of C-terminal GLP-1 (9.0+/-1.1 pmol......-1. The data suggest that in the anaesthetised pig, extraction occurs only in the kidney and can be fully accounted for by glomerular filtration....

  14. De novo glomerular diseases after renal transplantation.

    Science.gov (United States)

    Ponticelli, Claudio; Moroni, Gabriella; Glassock, Richard J

    2014-08-07

    Glomerular diseases developing in the kidney allograft are more often recurrences of the original disease affecting the native kidneys. However, in an undefined number of cases de novo, glomerular diseases unrelated to the original disease in the native kidneys can develop in the transplanted kidney. The clinical presentation and histologic features of de novo diseases are often similar to those features observed in patients with primary or secondary GN in the native kidneys. However, in transplanted kidneys, the glomerular, vascular, and tubulointerstitial changes are often intertwined with structural abnormalities already present at the time of transplant or caused by antibody- or cell-mediated allograft rejection, immunosuppressive drugs, or superimposed infection (most often of a viral nature). The pathophysiology of de novo glomerular diseases is quite variable. In rare cases of de novo minimal change disease, circulating factors increasing the glomerular permeability likely participate. Maladaptive hemodynamic changes and tissue fibrosis caused by calcineurin inhibitors or other factors may be involved in the pathogenesis of de novo FSGS. The exposure of cryptic podocyte antigens may favor the development of de novo membranous nephropathy. Many cases of de novo membranoproliferative GN are related to hepatitis C virus infection. Patients with Alport syndrome lacking antigenic epitopes in their glomerular basement membrane may develop antibodies against these glomerular basement membrane antigens expressed in the transplanted kidney. Infection may cause acute GN to have a heterogeneous clinical presentation and outcome. De novo pauci-immune GN in renal transplant is rare. Preexisting or acquired intolerance to glucose may, in the long term, cause diabetic nephropathy. The prognosis of de novo diseases depends on the type of GN, the severity of lesions caused by the alloimmune response, or the efficacy of immunosuppressive therapy. In most cases, the management

  15. Renal filtration function in patients with gout

    Directory of Open Access Journals (Sweden)

    N. N. Kushnarenko

    2016-01-01

    Full Text Available Aim. To study circadian blood pressure (BP profile in patients with gout depending on the presence of arterial hypertension (HT and their relationship to the renal filtration function.Material and methods. Patients with gout (n=87 were included into the study. All the patients underwent ambulatory BP monitoring (ABPM with the assessment of circadian BP profile, determination of uric acid serum levels, glomerular filtration rate (GFR was evaluated by CKD-EPI method. Depending on GFR level, all the patients were divided into 2 groups - with renal dysfunction or without one.Results. ABPM revealed circadian BP dysregulation in 55% of gout patients both with HT and without HT. Chronic kidney disease (CKD was revealed in 72.4% of male patients, with the prevalence in patients with HT (76.6 vs 61%; p<0.001. Correlations between uric acid levels and some ABPM indicators and GFR were determined.Conclusion. Obtained data suggest the contribution of hyperuricemia in disorders of systemic and renal hemodynamics, leading to the early development of CKD.

  16. Measurement of glomerular filtration rate by impulse synthesis: Clinical validation and optimization

    Energy Technology Data Exchange (ETDEWEB)

    Palagi, B.; Verga, P.; Broggi, A.; Picozzi, R.; Villa, F.; Guzzini, F.; Cozzi, C.; Tomasi, A.

    1988-08-01

    Impulse synthesis is a technique which relies upon the logic of continuous infusion but extracts the clearance value from single-injection data by shifting and adding them until an asymptotic value is attained. This study has been aimed at validating and optimizing clinically the measurement of glomerular filtration rate by impulse synthesis. A single intravenous injection of /sup 51/Cr-EDTA has been made in 32 patients and plasma activity monitored over the next 6 h. Glomerular filtration rate computed by a single-exponential fit method (GFR-SEF) has been shown to be significantly (p<0.001) overestimated when compared with the glomerular filtration rate obtained by the impulse synthesis technique (GFR-IS) in spite of an excellent (r=0.989) linear correlation between the two sets of data. On the other hand, the comparison between GFR-IS and 24-h creatinine clearance has not shown any significant difference. Moreover, we have found that in patients with severe renal failure GFR-IS is overestimated when the sampling time span is shortened to 3 h. On the other hand, GFR-IS is slightly underestimated in patients with severe renal failure when the convolution time interval is increased over a few minutes.

  17. Mechanisms responsible for decreased glomerular filtration in hibernation and hypothermia

    Science.gov (United States)

    Tempel, G. E.; Musacchia, X. J.; Jones, S. B.

    1977-01-01

    Measurements of blood pressure, heart rate, red blood cell and plasma volumes, and relative distribution of cardiac output were made on hibernating and hypothermic adult male and female golden hamsters weighing 120-140 g to study the mechanisms underlying the elimination or marked depression of renal function in hibernation and hypothermia. The results suggest that the elimination or marked depression in renal function reported in hibernation and hypothermia may partly be explained by alterations in cardiovascular system function. Renal perfusion pressure which decreases nearly 60% in both hibernation and hypothermia and a decrease in plasma volume of roughly 35% in the hypothermic animal might both be expected to markedly alter glomerular function.

  18. Drug Dosing in Patients with Renal Insufficiency in a Hospital Setting using Electronic Prescribing and Automated Reporting of Estimated Glomerular Filtration Rate

    DEFF Research Database (Denmark)

    Nielsen, Anita L.; Henriksen, Daniel Pilsgaard; Marinakis, Christianna;

    2014-01-01

    . We conclude that despite implementation of electronic prescribing and automated reporting of eGFR, patients with renal insufficiency may still be exposed to inappropriate drug use, with potential increased risk of adverse effects. Initiatives to reduce medication errors such as the use of electronic......GFR in the range of 10-49 ml/min/1.73m(2) were included. We identified 436 episodes with administration of renal risk drugs (prescribed to 183 patients): 410 drugs required dose adjustment according to the eGFR and 26 should be avoided. In total, the use or dosing of 66 (15%) of the 436 renal risk drugs...

  19. Pregnancy reduces the accuracy of the estimated glomerular filtration rate based on Cockroft-Gault and MDRD formulas

    NARCIS (Netherlands)

    Koetje, P.M.; Spaan, J.J.; Kooman, J.P.; Spaanderman, M.E.A.; Peeters, L.L.

    2011-01-01

    OBJECTIVE: This study aims to determine the effect of pregnancy on the accuracy of 3 commonly used methods to estimate glomerular filtration rate ([GFR] creatinine clearance, the Cockroft-Gault, and modification of diet in renal disease [MDRD] formulas) using the inulin clearance as a reference. DES

  20. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.

    NARCIS (Netherlands)

    Matsushita, K.; Mahmoodi, B.K.; Woodward, M.; Emberson, J.R.; Jafar, T.H.; Jee, S.H.; Polkinghorne, K.R.; Shankar, A.; Smith, D.H.; Tonelli, M.; Warnock, D.G.; Wen, C.P.; Coresh, J.; Gansevoort, R.T.; Hemmelgarn, B.R.; Levey, A.S.; Wetzels, J.F.

    2012-01-01

    CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk

  1. Differential effect of T-type voltage-gated calcium channel disruption on renal plasma flow and glomerular filtration rate in vivo

    DEFF Research Database (Denmark)

    Thuesen, Anne D; Andersen, Henrik; Cardel, Majken

    2014-01-01

    of two T-type Cav knock-out mice strains. Continuous recordings of blood pressure and heart rate, and para-aminohippurate clearance (renal plasma flow) and inulin clearance (GFR) were performed in conscious, chronically catheterized, wild type and Cav 3.1-/- and Cav 3.2-/- mice. Contractility of afferent...

  2. 螺旋CT多期扫描测定肾移植供体肾功能的价值%Glomerular filtration rate in living renal donor measured by helical CT multi-phase scanning

    Institute of Scientific and Technical Information of China (English)

    窦鑫; 周科峰; 李丹燕; 胡安宁; 杨尚文; 郭宏骞; 刘铁石; 朱斌

    2011-01-01

    目的:评价多层螺旋CT多期扫描测定肾移植供体肾功能的方法及应用.方法:58例活体肾移植供体行腹部多层螺旋CT多期(动脉期、实质期、排泄期)扫描,在动脉期与实质期之间插入5个低剂量全肾扫描序列,数据传入AW4.2工作站进行测量,根据全肾Patlak方程,计算单侧肾小球滤过率(glomerular filtration rate,GFR),同时与单光子发射计算机体层成像(single photon emission computed tomography,SPECT)所测定的单侧GFR相对照,进行直线回归与相关分析.结果:两种方法测定的GFR相关性良好,总肾的GFR相关系数r=0.904,直线回归方程为GFR(CT)=20.841+0.753×GFR(ECT),n=58,单侧GFR相关系数r=0.946,直线回归方程为GFR(CT)=7.086+0.864×GFR(ECT),n=116,配对t检验显示,两者测定的单侧及双侧GFR之间均无显著性差异(P>0.05).结论:螺旋CT多期扫描测定的移植肾供体的GFR结果准确,可以和同位素测定结果相互替代.%Objective:To evaluate the technique and application for measuring glomerular filtration rate in living renal donor by 16-slice spiral CT multi-phase scanning. Methods:58 living renal donors were underwent abdominal multi-phase enhancement CT scan, between the arterial and parenchymal phase. 5 continuous low dose kidney series were inserted. Using the known patlak equation, the GFR in a single kidney was calculated in CT scan and the exact information of GFR was gained by performing renal SPECT with Tc99m-TDPA. GFR of the two groups were analyzed by linear regression analysis. Results: Linear regression analysis show that the two groups GFR had very well associativity. The correlation coefficient of whole kidney and divided one is 0. 904 and 0. 946. With a line of regression GFR(CT) = 20. 841 + 0. 753 × GFR (ECT).n=58(the whole kidney); GFR(CT)=7. 086 + 0. 864 XGFR(ECT) .n= 116 (the divided kidney), they had no statistical significance in pair t test( P >0. 05). Conclusion:The GRF measured by multi-phase CT

  3. Assessing glomerular filtration rate in healthy adult potential kidney donors in Bangladesh: a comparison of various prediction equations with measured glomerular filtration rate by diethylentriamine pentaacetic acid renogram.

    Science.gov (United States)

    Jahan, F; Chowdhury, M N U; Mahbub, T; Arafat, S M; Jahan, S; Hossain, M; Khan, M F

    2013-08-01

    To ensure that potential kidney donors in Bangladesh have no renal impairment, it is extremely important to have accurate methods for evaluating the glomerular filtration rate (GFR). We evaluated the performance of serum creatinine based GFR in healthy adult potential kidney donors in Bangladesh to compare GFR determined by DTPA with that determined by various prediction equations. In this study GFR in 61 healthy adult potential kidney donors were measured with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram. We also estimated GFR using a four variable equation modification of diet in renal disease (MDRD), Cockcroft-Gault creatinine clearance (CGCrCl), Cockcroft-Gault glomerular filtration rate (CG-GFR). The mean age of study population was 34.31 +/- 9.46 years and out of them 65.6% was male. In this study mean mGFR was 85.4 +/- 14.8. Correlation of estimated GFR calculated by CG-CrCl, CG-GFR and MDRD were done with measured GFR DTPA using quartile. Kappa values were also estimated which was found to be 0.104 for (p = 0.151), 0.336 for (p = 0.001) and 0.125 for (p = 0.091) respectively. This indicates there is no association between estimated GFR calculated by CG-CrCl, CG-GFR, MDRD with measured GFR DTPA. These results show poor performance of these equations in evaluation of renal function among healthy population and also raise question regarding validity of these equations for assessment of renal function in chronic kidney disease in our population.

  4. Indexing Glomerular Filtration Rate to Body Surface Area

    DEFF Research Database (Denmark)

    Redal-Baigorri, Belén; Rasmussen, Knud; Heaf, James Goya

    2014-01-01

    BACKGROUND: Kidney function is mostly expressed in terms of glomerular filtration rate (GFR). A common feature is the expression as ml/min per 1.73 m(2) , which represents the adjustment of the individual kidney function to a standard body surface area (BSA) to allow comparison between individuals....... We investigated the impact of indexing GFR to BSA in cancer patients, as this BSA indexation might affect the reported individual kidney function. METHODS: Cross-sectional study of 895 adults who had their kidney function measured with (51) chrome ethylene diamine tetraacetic acid. Mean values of BSA...

  5. Influence of renal function on the measurement of glomerular filtration rate with Gates method%肾功能对Gates法肾小球滤过率实测值的影响

    Institute of Scientific and Technical Information of China (English)

    杨仪; 唐军; 田金玲; 陆文栋; 刘增礼

    2012-01-01

    Objective To investigate the influence of renal function on the measurement of glomerular filtration rate(GFR) with Gates method. Methods In 155 cases with different kidney disease(95 male, 60 female; 19-83 years old) , having impairment of re-nal function to varying degrees,renal dynamic imaging was performed by 99Tcm-DTPA and GFR was measured twice using Gates method both by two different manipulators in 73 cases and by the same manipulator at more than 3 months interval in 82 cases. Two groups of cases were divided into A stages according to mean GFR. All GFR at different stages in two groups were analyzed with the matched t-test to reveal if there were significant differences between the before-and-after GFR measured by different manipulators or by same manipulator at different time. Coefficient of variation(CV) of GFR at different stages was obtained to explore the rela-tionship between CV and renal function(mean GFR). Results There were not statistically significant differences of GFR between the before-and-after GFR measured by different manipulators or by same manipulator at different time in all cases(P>0. 05). With decline of renal function from stage Ⅰ to stage Ⅳ of chronic kidney disease(CKD) ,CV became larger. They were in negative corre-lation and the regression equations were Y= -0. 09X+10. 22(r=0. 60)by two different manipulators and Y= - 0. 11X311. 23(r = 0. 66)by the same manipulator. Conclusion Deviation at different extent in measuring GFR with Gates method exists at different stages of renal function. The worse the renal function is,the greater the deviation rises.%目的 探讨肾功能对Gates法测定肾小球滤过率(GFR)实测值的影响.方法 对155例慢性肾脏病(CKD)患者进行99Tcm-DTPA肾动态显像,采用Gates法测定GFR,其中73例由两位不同操作者进行肾脏ROI的勾画,82例由同一操作者在不同的时间进行两次ROI勾画,将所得的GFR进行分析比较,观察在不同的肾功能状态下由于肾

  6. Progression of glomerular filtration rate reduction determined in conscious Dahl salt-sensitive hypertensive rats.

    Science.gov (United States)

    Cowley, Allen W; Ryan, Robert P; Kurth, Terry; Skelton, Meredith M; Schock-Kusch, Daniel; Gretz, Norbert

    2013-07-01

    Sequential changes in glomerular filtration rate during development of hypertension in the conscious Dahl salt-sensitive rats were determined using a new method for measurement. Using a miniaturized device, disappearance curves of fluorescein isothiocyanate-sinistrin were measured by transcutaneous excitation and real-time detection of the emitted light through the skin. Rats with implanted femoral venous catheters (dye injection and sampling) and carotid catheters (mean arterial pressure by telemetry) were studied, while maintained on a 0.4% NaCl diet and on days 2, 5, 7, 14, and 21 after switching to 4.0% (high-salt [HS]) diet. A separate group of rats were maintained on 0.4% for 21 days as a time control. Mean arterial pressure rose progressively from the last day of 0.4% (130±2 mm Hg) reaching significance by day 5 of HS and averaged 162±7 mm Hg by day 21. Urine albumin excretion was significantly elevated (×3) by day 7 of HS in Dahl salt-sensitive rats. Glomerular filtration rate reduced on day 14 of HS falling from 1.53±0.06 mL/min per 100 g body weight to 1.27±0.04. By day 21, glomerular filtration rate had fallen 28% to 1.1±0.04 mL/min per 100 g (t(1/2) 28.4±1.1 minute.) No significant reductions of creatinine clearance were observed throughout the study in response to HS demonstrating the insensitivity of creatinine clearance measurements even with creatinine measured using mass spectrometry. We conclude that the observed reduction of glomerular filtration rate was a consequence and not a cause of the hypertension and that this noninvasive approach could be used in these conscious Dahl salt-sensitive rats for a longitudinal assessment of renal function.

  7. Rapid decline in glomerular filtration rate during the first weeks following heart transplantation

    DEFF Research Database (Denmark)

    Hornum, M; Andersen, M; Gustafsson, F

    2011-01-01

    We hypothesized that a decrease in renal function is seen immediately after heart transplantation (HTX) with little recovery over time. Twelve consecutive patients had their glomerular filtration rate (GFR) measured using (51)Cr-ethylenediaminetetraacetic acid (EDTA) measured GFR (mGFR) before...... transplantation and at 1, 2, 3, and 26 weeks after transplantation. The mGFR decreased by 28% and 24% during the first 3 and 26 weeks, respectively, with mean blood cyclosporine concentration as an independent risk factor for the decrease in mGFR. The identification of cyclosporine A (CsA) as the most important...

  8. Radionuclide Renal Dynamic Imaging GFR (glomerular filtration rate) to Evaluate Renal Function and Serum Creatinine (Scre) Evaluation Comparison of Renal Clearance%核素肾动态显像GFR测定与肌酐清除率评价肾功能的相关性比较

    Institute of Scientific and Technical Information of China (English)

    张晓; 孙莲华

    2014-01-01

    Objective:To study radionuclide renal dynamic imaging GFR ( glomerular filtration rate ) to evaluate renal function and se-rum creatinine ( Scre) evaluation comparison of renal clearance .Methods:First estimation of normal reference value of my GFR in the control group;when renal function damage of 80 cases, measurement of GFR and creatinine clearance rate comparison of measurement val-ues.Results:80 cases patients of GFR and muscle anhydride cleared rate contrast , GFR and serum muscle anhydride are exception who 63 cases, its GFR value 81.3 ±12.8ml/min and muscle anhydride cleared rate 85.5 ±11.3ml/min, differences no significantly sexual meaning (P>0.05);12 cases chronic kidney damage patients , muscle anhydride cleared rate 70.1 ±8.3ml/min,GFR value 50.2 ± 6.8ml/min, differences has significantly sexual meaning ( P<0.01); Value of 5 patients with severe hydronephrosis GFR 19.1 ±7. 3ml/min, 23.6 ±5.8ml/min creatinine clearance rate, the difference has a significant meaning (P<0.01).Radionuclide renal dynam-ic values of GFR and creatinine clearance rate more in line with;early GFR and impaired renal function creatinine clearance rate of earlier abnormal changes .Conclusion:Radionuclide renal dynamic checking GFR determination can better reflect the change rate of Glomerular filtration function in early stage , a more accurate estimation of renal function .%目的:探讨放射性核素肾动态显像GFR(肾小球滤过率)评价肾功能与血清肌酐( Scre)清除率评价肾功能的比较。方法:首先对照组估算我科GFR的正常参考值;80例当肾功能受损害时,GFR的测量值与血清肌酐清除率测定值的比较。结果:80例患者的GFR与肌酐清除率对比,GFR和血清肌酐均异常者63例,其GFR值81.3±12.8ml/min与肌酐清除率85.5±11.3ml/min,差异无显著性意义(P>0.05);12例慢性肾损害患者,肌酐清除率70.1±8.3ml/min,GFR值50.2±6.8ml

  9. Ultrastructural model for size selectivity in glomerular filtration.

    Science.gov (United States)

    Edwards, A; Daniels, B S; Deen, W M

    1999-06-01

    A theoretical model was developed to relate the size selectivity of the glomerular barrier to the structural characteristics of the individual layers of the capillary wall. Thicknesses and other linear dimensions were evaluated, where possible, from previous electron microscopic studies. The glomerular basement membrane (GBM) was represented as a homogeneous material characterized by a Darcy permeability and by size-dependent hindrance coefficients for diffusion and convection, respectively; those coefficients were estimated from recent data obtained with isolated rat GBM. The filtration slit diaphragm was modeled as a single row of cylindrical fibers of equal radius but nonuniform spacing. The resistances of the remainder of the slit channel, and of the endothelial fenestrae, to macromolecule movement were calculated to be negligible. The slit diaphragm was found to be the most restrictive part of the barrier. Because of that, macromolecule concentrations in the GBM increased, rather than decreased, in the direction of flow. Thus the overall sieving coefficient (ratio of Bowman's space concentration to that in plasma) was predicted to be larger for the intact capillary wall than for a hypothetical structure with no GBM. In other words, because the slit diaphragm and GBM do not act independently, the overall sieving coefficient is not simply the product of those for GBM alone and the slit diaphragm alone. Whereas the calculated sieving coefficients were sensitive to the structural features of the slit diaphragm and to the GBM hindrance coefficients, variations in GBM thickness or filtration slit frequency were predicted to have little effect. The ability of the ultrastructural model to represent fractional clearance data in vivo was at least equal to that of conventional pore models with the same number of adjustable parameters. The main strength of the present approach, however, is that it provides a framework for relating structural findings to the size

  10. Radioactive chromium-ethylenediaminetetraacetic acid for determination of glomerular filtration rate in rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Tvedegaard, E.; Kamstrup, O.

    1981-12-01

    Simultaneous determination of the glomerular filtration rate was made by the insulin clearance technique and by analysis of the plasma disappearance curve of radioactive chromium-ethylenediaminetetraacetic acid (/sup 51/Cr-EDTA) following an intravenous injection in 28 anaesthetized rabbits. In some rabbits, the renal function was reduced by previous surgery. The insulin clearances ranged from 2.7 to 17 ml/minute. By a double-exponential analysis of the plasma disappearance curve, the total plasma clearance of /sup 51/Cr-EDTA was found to exceed the inulin clearance by 12%. By the simpler slope-intercept analysis requiring only two blood samples, this value was 32%. The renal clearance of /sup 51/Cr-EDTA was 97% of inulin clearance. In nephrectomized rabbits, plasma clearance of /sup 51/Cr-EDTA was 0.7 ml/minute. At all levels of renal function, measurement of the plasma clearance rate of /sup 51/Cr-EDTA by the single injection technique allowed a fairly reliable estimate of the glomerular filtration rate.

  11. Avaliação do ritmo de filtração glomerular Assessment of glomerular filtration rate

    Directory of Open Access Journals (Sweden)

    Gianna Mastroianni Kirsztajn

    2007-08-01

    Full Text Available A medida do ritmo de filtração glomerular (RFG é a prova laboratorial mais utilizada na avaliação da função renal. Para tanto, usam-se marcadores indiretos, como as determinações de creatinina e cistatina C no sangue, ou procede-se à determinação do RFG propriamente dito, com indicadores como inulina; contrastes iodados, marcados ou não; e outras substâncias. O exame mais solicitado para avaliação do RFG no laboratório de patologia clínica é a dosagem da creatinina sérica. Em algumas condições, entretanto, o resultado encontrado da creatinina sérica deve ser corrigido (através da utilização de fórmulas que levam em consideração características próprias do indivíduo para ser devidamente interpretado. De fato, a inulina ainda é vista como marcador ideal de filtração glomerular, mas seu uso não se destina à prática clínica, de modo que ainda hoje persiste a busca por testes adequados para uso rotineiro.Glomerular filtration rate (GFR determination is the most frequently used laboratorial test to evaluate renal function. Indirect markers as blood determination of creatinine and cystatin C are used with this purpose, as well as the direct determination of GFR, with indicators like inulin; iodated contrasts, radioactive or not; and others. Serum creatinine is the test that is most commonly performed in order to evaluate GFR in the clinical pathology laboratory. However, in some conditions, aiming at the adequate interpretation of the test, the result of serum creatinine must be corrected (by using formulas that include individual characteristics of the subjects. In fact, inulin is still seen as the ideal marker of glomerular filtration, but its use is not directed to clinical practice; then the search for appropriate tests for routine use continues.

  12. Glomerular filtration rate and segmental tubular function in the early phase after transplantation/uninephrectomy in recipients and their living-related kidney donors

    DEFF Research Database (Denmark)

    Kamper, A L; Holstein-Rathlou, N H; Strandgaard, S;

    1994-01-01

    1. Glomerular filtration rate and sequential tubular function were investigated in 18 adult renal transplant recipients and in their matched, adult living-related kidney donors before and 5 days after transplantation/uninephrectomy. At day 54, 13 donors and 11 recipients were re......-investigated. Sixteen of these constituted eight matched pairs. This reduction in the study population was caused by the application of two withdrawal criteria. 2. In the recipients glomerular filtration rate was unchanged at day 5 and had increased to 61 ml/min at day 54 (P glomerular filtration....../min to 2.10 ml/min at day 54 (P glomerular filtration rate, lithium clearance, absolute and fractional proximal...

  13. Aging and physiological changes of the kidneys including changes in glomerular filtration rate.

    Science.gov (United States)

    Musso, Carlos G; Oreopoulos, Dimitrios G

    2011-01-01

    In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water-soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease.

  14. Estimated glomerular filtration rate by serum creatinine or standardized cystatin C in Japanese patients with Graves׳ disease.

    Science.gov (United States)

    Suzuki, Yoshitake; Matsushita, Kazuyuki; Seimiya, Masanori; Yoshida, Toshihiko; Sawabe, Yuji; Ogawa, Makoto; Nomura, Fumio

    2015-12-01

    Glomerular filtration rate (eGFR) by serum creatinine (eGFRCr) or standardized cystatin C (eGFRCysC) were estimated in Japanese patients with Graves׳ disease (GD) of different sex. Clinical samples were collected from patients with GD with normal renal function to accurately validate eGFRCr and eGFRCysC levels and evaluate how hyperthyroidism affects renal function. Levels of eGFRCr and eGFRCysC showed clinical usefulness in successfully treated euthyroid patients with GD regardless of sex. The article includes detailed experimental methods and data used in our analysis. The data relates to the "Paradoxical effect of thyroid function on the estimated glomerular filtration rate by serum creatinine or standardized cystatin C in Japanese Graves' disease patients" (Suzuki et al., 2015) [1].

  15. Salt sensitivity of renin secretion, glomerular filtration rate and blood pressure in conscious Sprague-Dawley rats

    DEFF Research Database (Denmark)

    Isaksson, G L; Stubbe, J; Hansen, Per Lyngs;

    2014-01-01

    We hypothesized that in normal rats in metabolic steady state, (i) the plasma renin concentration (PRC) is log-linearly related to Na(+) intake (NaI), (ii) the concurrent changes in mean arterial pressure (MABP) and glomerular filtration rate (GFR) are negligible and (iii) the function PRC = f(Na...... = f(NaI) is altered by β1 -adrenoceptor blockade (metoprolol) and surgical renal denervation (DNX)....

  16. MDRD or CKD-EPI for glomerular filtration rate estimation in living kidney donors.

    Science.gov (United States)

    Burballa, Carla; Crespo, Marta; Redondo-Pachón, Dolores; Pérez-Sáez, María José; Mir, Marisa; Arias-Cabrales, Carlos; Francés, Albert; Fumadó, Lluis; Cecchini, Lluis; Pascual, Julio

    2017-04-12

    The evaluation of the measured Glomerular Filtration Rate (mGFR) or estimated Glomerular Filtration Rate (eGFR) is key in the proper assessment of the renal function of potential kidney donors. We aim to study the correlation between glomerular filtration rate estimation equations and the measured methods for determining renal function. We analysed the relationship between baseline GFR values measured by Tc-(99)m-DTPA (diethylene-triamine-pentaacetate) and those estimated by the four-variable Modification of Diet in Renal Disease (MDRD4) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in a series of living donors at our institution. We included 64 donors (70.6% females; mean age 48.3±11 years). Baseline creatinine was 0.8±0.1 mg/dl and it was 1.1±0.2 mg/dl one year after donation. The equations underestimated GFR when measured by Tc(99)m-DTPA (MDRD4-9.4 ± 25ml/min, P<.05, and CKD-EPI-4.4 ± 21ml/min). The correlation between estimation equations and the measured method was superior for CKD-EPI (r=.41; P<.004) than for MDRD4 (r=.27; P<.05). eGFR decreased to 59.6±11 (MDRD4) and 66.2±14ml/min (CKD-EPI) one year after donation. This means a mean eGFR reduction of 28.2±16.7 ml/min (MDRD4) and 27.31±14.4 ml/min (CKD-EPI) at one year. In our experience, CKD-EPI is the equation that better correlates with mGFR-Tc(99)m-DTPA when assessing renal function for donor screening purposes. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Measurement of single-kidney glomerular filtration function from magnetic resonance perfusion renography

    Energy Technology Data Exchange (ETDEWEB)

    Zeng, Meiying; Cheng, Yingsheng [Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai 200233 (China); Zhao, Binghui, E-mail: binghuizhao@163.com [Department of Radiology, Shanghai Tenth People' s Hospital, Tongji University, Shanghai 200072 (China)

    2015-08-15

    Highlights: • MRPR monitors the transit of contrast material through nephron. • MRPR could reveal renal physiological characteristics in quality and quantity. • This review outlines the basics and future challenges of DCE MRPR. - Abstract: Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney, and is considered to be the reference standard in the evaluation of renal function. There are many ways to test the GFR clinically, such as serum creatinine concentration, blood urea nitrogen and SPECT renography, however, they’re all not a good standard to evaluate the early damage of renal function. In recent years, the improvement of MRI hardware and software makes it possible to reveal physiological characteristics such as renal blood flow or GFR by dynamic contrast enhancement magnetic resonance perfusion renography (DEC MRPR). MRPR is a method used to monitor the transit of contrast material, typically a gadolinium chelate, through the renal cortex, the medulla, and the collecting system. This review outlines the basics of DCE MRPR included acquisition of dynamic MR perfusion imaging, calculation of the contrast concentration from signal intensity and compartment models, and some challenges of MRPR method faced in prospective clinical application.

  18. 99mTc-DTPA肾动态显像法测定健康人GFR的研究%Study on 99 mTc-DTPA Renal Dynamic Imaging for Detecting Glomerular Filtration Rate in Healthy People

    Institute of Scientific and Technical Information of China (English)

    杨吉刚; 李春林; 邹兰芳; 张楠

    2011-01-01

    [Objective] To observe the normal value of glomerular filtration rate(GFR) in healthy people detected by 99 mTc-DTPA renal dynamic imaging and its change with the age. [Methods] The case history was inquired. Blood pressure, fasting blood glucose, lipids and serum creatinine were determined. Urine routine test, urine proteins and 24h-urinary protein quantitive test, urinary sediment microscopic examination, renal ultrasound and renal biopsy were performed. The selection and exclusion criteria were strictly formulated. Radionuclide imaging was used to detect the GFR. [Results]The average GFR value in the healthy adults was (87.68±16.74)mL/(min · 1.73 m2). There was no significant difference in GFR of different gender in the same age group. There was no significant difference in GFR in men among different age groups. There was significant different in GFR between women aged more than 50 years old and women aged less than 50 years old[(83.36±10.15)mL/(min · 1.73 m2) , (95.32±13.91)mL/(min · 1.73 m2) , (91.24±16.46)mL/(min · 1.73 m2), (98. 92±11. 35)mL/(min· 1.73 m2)].[Conclusion]The GFR in healthy people detected by 99 mTc-DTPA renal dynamic imaging is different from that in western people. The GFR in women aged over 50 years old has a trend of decline.%[目的]观察99mTc-DTPA肾动态显像法测定健康人肾小球滤过率(GFR)的正常值,以及健康人随着年龄增长GFR值的变化.[方法]通过询问病史,测量血压,测定空腹血糖、血脂、血肌酐、尿常规、尿蛋白4项、24 h尿蛋白定量,尿沉渣镜检,肾脏超声及肾穿刺病理结果,严格制定入选标准及排除标准,并采用放射性核素显像测定GFR.[结果]健康成人的平均GFR值为(87.68±16.74)mL/(min·1.73 m2),142例受试者按年龄段分为20~,30~,40~,50~四组.相同年龄组中不同性别GFR值差异无统计学意义,男性各年龄组的GFR值差异无统计学意义.在>50岁女性的GFR和≤50岁女性各

  19. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: How to measure glomerular filtration rate with iohexol?

    Science.gov (United States)

    Delanaye, Pierre; Ebert, Natalie; Melsom, Toralf; Gaspari, Flavio; Mariat, Christophe; Cavalier, Etienne; Björk, Jonas; Christensson, Anders; Nyman, Ulf; Porrini, Esteban; Remuzzi, Giuseppe; Ruggenenti, Piero; Schaeffner, Elke; Soveri, Inga; Sterner, Gunnar; Eriksen, Bjørn Odvar; Bäck, Sten-Erik

    2016-01-01

    While there is general agreement on the necessity to measure glomerular filtration rate (GFR) in many clinical situations, there is less agreement on the best method to achieve this purpose. As the gold standard method for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtration markers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFR marker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, but multiple-sample protocols may be more accurate in specific situations. In low GFRs one or more late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method. PMID:27679715

  20. Glomerular filtration rate is associated with burden of coronary atherosclerosis in patients with acute coronary syndrome.

    Science.gov (United States)

    Duran, Mustafa; Uysal, Onur Kadir; Gunebakmaz, Ozgur; Baran, Oguzhan; Turfan, Murat; Ornek, Ender; Cetin, Mustafa; Murat, Sani Namik; Yarlioglues, Mikail; Karadeniz, Muhammed; Kurtul, Alpaslan; Kaya, Mehmet Gungor

    2014-04-01

    We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR >90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m(2). Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (>50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender.

  1. An overview of glomerular filtration rate testing in dogs and cats

    Science.gov (United States)

    Von Hendy-Willson, Vanessa E.; Pressler, Barrak M.

    2010-01-01

    Determination of glomerular filtration rate (GFR) is a valuable, yet underused, diagnostic tool for evaluating renal function in dogs and cats. This article first reviews the hormonal and hemodynamic factors which contribute to GFR, followed by a description of considerations when selecting a pharmacokinetic model and methods of animal-to-animal standardization. The best-characterized existing GFR markers, including creatinine, radiolabeled markers, and iohexol, are reviewed in depth, as well as alternative but lesser-used techniques. A weighted means analysis of reported GFR measurements in healthy dogs and cats and a review of selected studies that have examined GFR alterations in animals with naturally-occurring and experimental diseases provide the reader with preliminary guidelines on expected GFR results in these species and disease conditions. PMID:20541957

  2. [Consensus document: recommendations for the use of equations to estimate glomerular filtration rate in children].

    Science.gov (United States)

    Montañés Bermúdez, R; Gràcia Garcia, S; Fraga Rodríguez, G M; Escribano Subias, J; Diez de Los Ríos Carrasco, M J; Alonso Melgar, A; García Nieto, V

    2014-05-01

    The appearance of the K/DOQI guidelines in 2002 on the definition, evaluation and staging of chronic kidney disease (CKD) have led to a major change in how to assess renal function in adults and children. These guidelines, recently updated, recommended that the study of renal function is based, not only on measuring the serum creatinine concentration, but this must be accompanied by the estimation of glomerular filtration rate (GFR) obtained by an equation. However, the implementation of this recommendation in the clinical laboratory reports in the paediatric population has been negligible. Numerous studies have appeared in recent years on the importance of screening and monitoring of patients with CKD, the emergence of new equations for estimating GFR, and advances in clinical laboratories regarding the methods for measuring plasma creatinine and cystatin C, determined by the collaboration between the departments of paediatrics and clinical laboratories to establish recommendations based on the best scientific evidence on the use of equations to estimate GFR in this population. The purpose of this document is to provide recommendations on the evaluation of renal function and the use of equations to estimate GFR in children from birth to 18 years of age. The recipients of these recommendations are paediatricians, nephrologists, clinical biochemistry, clinical analysts, and all health professionals involved in the study and evaluation of renal function in this group of patients.

  3. Transcutaneous measurement of glomerular filtration rate in small rodents: through the skin for the win?

    Science.gov (United States)

    Ellery, Stacey J; Cai, Xiaochu; Walker, David D; Dickinson, Hayley; Kett, Michelle M

    2015-03-01

    Rodent models of renal physiology and pathology are crucial to our understanding of the molecular, histological and functional sequelae that contribute to kidney diseases. One of the most important measures of renal function is glomerular filtration rate (GFR). While the accurate determination of GFR is pivotal to understanding the progression of disease and/or the benefits of treatment strategies, in rodents the conventional methods for assessment of GFR are inconvenient and cumbersome, not the least because they involve stress and often anaesthesia. The legitimacy of assay-based assessment of plasma and urine markers of GFR in mice has also been heavily scrutinized for their insensitivity to minor declines in GFR and inaccurate detection of renal biomarkers. While infusion-based clearance methods of GFR assessment are thus the gold standard in terms of accuracy, they are limited by the fact that they are primarily non-recovery procedures. This presents a dilemma when trying to document the progression of renal disease, as these measures cannot be taken in the same experimental subject. Here we review a technique of transcutaneous measurement of fluorescein isothiocyanate-labelled sinistrin to calculate GFR in small rodents, using a non-invasive clearance device (NIC-Kidney Device). This is a recently validated non-invasive technique for measuring GFR in small rodents that allows for the real-time measurement of GFR in conscious animals, without the need for plasma and urine assays.

  4. Glomerular endothelial surface layer acts as a barrier against albumin filtration

    NARCIS (Netherlands)

    Dane, M.J.; Berg, B.M. van den; Avramut, M.C.; Faas, F.G.; Vlag, J. van der; Rops, A.L.; Ravelli, R.B.; Koster, B.J.; Zonneveld, A.J. van; Vink, H.; Rabelink, T.J.

    2013-01-01

    Glomerular endothelium is highly fenestrated, and its contribution to glomerular barrier function is the subject of debate. In recent years, a polysaccharide-rich endothelial surface layer (ESL) has been postulated to act as a filtration barrier for large molecules, such as albumin. To test this hyp

  5. Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens D; Ross, Michael

    2016-01-01

    of exposure to antiretrovirals and the development of chronic kidney disease in people with initially normal renal function, as measured by estimated glomerular filtration rate (eGFR). METHODS: In this prospective international cohort study, HIV-positive adult participants (aged ≥16 years) from the D...

  6. Beta thalassemia major: The effect of age on glomerular filtration rate

    Directory of Open Access Journals (Sweden)

    Majid Malaki

    2011-01-01

    Full Text Available Thalassemia is a common hereditary hemoglobinopathy disorder that affects many organs in the body. Estimation of kidney function is important, as it is the vital organ that plays the major role in the elimination of accumulated iron as well as the chelating drugs that have to be used as therapy. Sixty- three patients aged 1-29 years, with a mean ± SD of 14 ± 6.7 years, affected with beta- thalassemia major in Tabriz Children′s Hospital were evaluated for their renal function on the basis of their age, serum iron, serum ferritin and serum creatinine levels along with two methods of estimating glomerular filtration rate (GFR; by Schwartz method for those under 18 years old and using Modification of Diet in Renal Disease (MDRD formula for those who were 18 years and above. Elevation of serum creatinine denoting renal dysfunction was not seen in our patients, but hyperfiltration was a common finding. An increasing GFR was observed, which corresponded to age, but no relationships were seen between serum iron, serum ferritin, regular blood transfusion, chelating therapy to GFR.

  7. Evaluation of cystatin C as an endogenous marker of glomerular filtration rate in dogs.

    Science.gov (United States)

    Almy, Frederic S; Christopher, Mary M; King, Don P; Brown, Scott A

    2002-01-01

    Cystatin C is a cysteine protease inhibitor produced by all nucleated cells. It is freely filtered by the glomerulus and is unaffected by nonrenal factors such as inflammation and gender. Because of greater sensitivity and specificity, cystatin C has been proposed to replace creatinine as a marker of glomerular filtration rate (GFR) in humans. The aims of this study were to validate an automated assay in canine plasma and to evaluate the usefulness of cystatin C as a marker of GFR in dogs. Western blotting was used to demonstrate cross-reactivity of an anti-human cystatin C antibody. An immunoturbidimetric assay was used to detect cystatin C in 25 clinically healthy dogs and 25 dogs with renal failure. Mean cystatin C concentration in the healthy dogs and the dogs with renal failure was 1.08 +/- 0.16 mg/L and 4.37 +/- 1.79 mg/L respectively. Intra- and interassay variability was exogenous creatinine clearance had been determined previously. In the remnant kidney model, cystatin C was better correlated with GFR than creatinine (r = .79 versus .54) but was less well correlated with GFR in volume-depleted dogs (r = .54 versus .95). GFR measurements were repeated in the remnant kidney model dogs 60 days after initial GFR measurements. At this time, cystatin C and creatinine concentrations correlated equally well with GFR (r = .891 versus .894, respectively). Cystatin C concentration is a reasonable alternative to creatinine for screening dogs with decreased GFR due to chronic renal failure.

  8. Rosiglitazone Did Not Induce Acute Kidney Injury in Normocholesterolemic Rats Despite Reduction in Glomerular Filtration Rate

    Directory of Open Access Journals (Sweden)

    Cristiano Dias

    2014-04-01

    Full Text Available Background/Aims: Rosiglitazone (RGL has been used to ameliorate lipids homeostasis and also to treat inflammatory diseases. However, RGL may reduce renal blood flow and glomerular filtration rate (GFR predisposing to acute kidney injury (AKI. We investigated whether the treatment with RGL induces AKI in normocholesterolemic (NC and hypercholesterolemic (HC rats. Methods: We measured GFR by inulin clearance technique and we quantified urinary neutrophil gelatinase-associated lipocalin (uNGAL in all groups at baseline and during Ang II-stimulated vasoconstriction. Moreover, we evaluated the presence of renal damaged by histologic examination. Results: At baseline, NC and HC had normal and similar GFR. RGL treatment reduced GFR only in NC+RGL. Unexpectedly, HC+RGL showed high levels of uNGAL although GFR was at normal range. During Ang II-stimulated vasoconstriction, all groups showed reduction in GFR to the same range and we found high levels of uNGAL and high score of renal damage in HC and HC+RGL. Conclusion: RGL acts distinctly in normocholesterolemia and in hypercholesterolemia. Reduction in GFR provoked by RGL treatment did not allow the diagnosis of AKI in NC even in the presence of ANG II-stimulated vasoconstriction. However, AKI was diagnosed in HC+RGL at baseline although GFR was within normal range.

  9. Resolution of the three dimensional structure of components of the glomerular filtration barrier

    DEFF Research Database (Denmark)

    Arkill, Kenton P; Qvortrup, Klaus; Starborg, Tobias

    2014-01-01

    The human glomerulus is the primary filtration unit of the kidney, and contains the Glomerular Filtration Barrier (GFB). The GFB had been thought to comprise 3 layers - the endothelium, the basement membrane and the podocyte foot processes. However, recent studies have suggested that at least two...

  10. Measurement of glomerular filtration rate in adults: accuracy of five single-sample plasma clearance methods

    DEFF Research Database (Denmark)

    Rehling, M; Rabøl, A

    1989-01-01

    After an intravenous injection of a tracer that is removed from the body solely by filtration in the kidneys, the glomerular filtration rate (GFR) can be determined from its plasma clearance. The method requires a great number of blood samples but collection of urine is not needed. In the present...

  11. Individualizing Pharmacotherapy in Patients with Renal Impairment: The Validity of the Modification of Diet in Renal Disease Formula in Specific Patient Populations with a Glomerular Filtration Rate below 60 Ml/Min. A Systematic Review

    NARCIS (Netherlands)

    Eppenga, W.L.; Kramers, C.; Derijks, H.J.; Wensing, M.; Wetzels, J.F.M.; Smet, P.A.G.M. de

    2015-01-01

    BACKGROUND: The Modification of Diet in Renal Disease (MDRD) formula is widely used in clinical practice to assess the correct drug dose. This formula is based on serum creatinine levels which might be influenced by chronic diseases itself or the effects of the chronic diseases. We conducted a syste

  12. Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance.

    Science.gov (United States)

    Deng, Fang; Finer, Gal; Haymond, Shannon; Brooks, Ellen; Langman, Craig B

    2015-03-01

    Estimating glomerular filtration rate (eGFR) has become popular in clinical medicine as an alternative to measured GFR (mGFR), but there are few studies comparing them in clinical practice. We determined mGFR by iohexol clearance in 81 consecutive children in routine practice and calculated eGFR from 14 standard equations using serum creatinine, cystatin C, and urea nitrogen that were collected at the time of the mGFR procedure. Nonparametric Wilcoxon test, Spearman correlation, Bland-Altman analysis, bias (median difference), and accuracy (P15, P30) were used to compare mGFR with eGFR. For the entire study group, the mGFR was 77.9 ± 38.8 mL/min/1.73 m(2). Eight of the 14 estimating equations demonstrated values without a significant difference from the mGFR value and demonstrated a lower bias in Bland-Altman analysis. Three of these 8 equations based on a combination of creatinine and cystatin C (Schwartz et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629-37; Schwartz et al. Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C. Kidney Int 2012;82:445-53; Chehade et al. New combined serum creatinine and cystatin C quadratic formula for GFR assessment in children. Clin J Am Soc Nephrol 2014;9:54-63) had the highest accuracy with approximately 60% of P15 and 80% of P30. In 10 patients with a single kidney, 7 with kidney transplant, and 11 additional children with short stature, values of the 3 equations had low bias and no significant difference when compared with mGFR. In conclusion, the 3 equations that used cystatin C, creatinine, and growth parameters performed in a superior manner over univariate equations based on either creatinine or cystatin C and also had good applicability in specific pediatric patients with single kidneys, those with a kidney transplant, and short stature. Thus, we suggest that eGFR calculations in pediatric clinical practice

  13. Chronic changes of hematocrit value alter blood pressure and glomerular filtration in spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    Milanović S.

    2012-01-01

    Full Text Available Many studies in hypertensive humans and animals have shown that increased blood viscosity is in direct relation with essential hypertension. The aim of our studies was to investigate the effects of chronic hematocrit value changes on arterial blood pressure and kidney function in genetically induced hypertension. To this end, we studied the effects of several interventions, designed to increase/decrease hematocrit, on hemodynamic parameters, vascular reactivity, glomerular filtration and renal function curve in spontaneously hypertensive rats (SHR. Results of our study show that chronic hematocrit value elevation increases blood pressure and peripheral vascular resistance in SHR. On the other hand, chronic hematocrit lowering elucidates blood pressure and peripheral vascular resistance decrease followed by cardiac output rising. Both hematocrit value changes significantly reduce vasodilatory vascular response. Hematocrit lowering induces acute renal failure. Sodium excretion is shifted to higher blood pressure values in high hematocrit value animals and opposite - lower blood pressure values in low hematocrit value animals. Repeated transfusions develop salt sensitive malignant hypertension in SHR. Further studies are necessary to evaluate the degree of kidney damage after chronic hematocrit value changes in SHR.

  14. Prediction of hospital mortality by changes in the estimated glomerular filtration rate (eGFR).

    LENUS (Irish Health Repository)

    Berzan, E

    2015-03-01

    Deterioration of physiological or laboratory variables may provide important prognostic information. We have studied whether a change in estimated glomerular filtration rate (eGFR) value calculated using the (Modification of Diet in Renal Disease (MDRD) formula) over the hospital admission, would have predictive value. An analysis was performed on all emergency medical hospital episodes (N = 61964) admitted between 1 January 2002 and 31 December 2011. A stepwise logistic regression model examined the relationship between mortality and change in renal function from admission to discharge. The fully adjusted Odds Ratios (OR) for 5 classes of GFR deterioration showed a stepwise increased risk of 30-day death with OR\\'s of 1.42 (95% CI: 1.20, 1.68), 1.59 (1.27, 1.99), 2.71 (2.24, 3.27), 5.56 (4.54, 6.81) and 11.9 (9.0, 15.6) respectively. The change in eGFR during a clinical episode, following an emergency medical admission, powerfully predicts the outcome.

  15. Correlation of renal AQP1-4 protein expression with renal parenchyma thickness and glomerular filtration rate in children with congenital hydronephrosis%先天性肾积水患儿肾脏水通道蛋白表达与肾实质厚度和肾小球滤过率的相关性

    Institute of Scientific and Technical Information of China (English)

    李真珍; 王志敏; 邢璐; 张红; 文建国

    2011-01-01

    目的 探讨先天性肾积水患儿肾脏水通道蛋白AQP1-4的表达与肾实质厚度和肾小球滤过率(GFR)变化之间的关系.方法 利用Western blot检测AQP1-4蛋白在10例先天性肾积水患儿(年龄62.3±18.3个月)10个肾组织和6例来自肾母细胞瘤手术切除患儿的正常肾脏组织(年龄62.7±17.1个月)中的相对表达量.同时对患侧肾脏肾实质厚度和GFR进行评估.积水肾脏AQPI-4表达与GFR以及肾实质厚度之间进行Pearson相关分析检验.结果 肾积水组AQPI-4蛋白相对表达均明显低于正常组(P<0.05).B超测量术前积水侧肾脏肾实质厚度平均为4.59 +2.25 mm.99mTc-DTPA测定积水侧肾脏GFR较对侧肾脏明显下降(40±12 mL/min vs 105±20 mL/min,P<0.05).积水组肾脏中AQP1-4蛋白相对表达量与肾实质厚度之间呈正相关,与患侧肾脏GFR之间亦呈正相关.积水侧肾脏肾实质厚度与GFR之间呈正相关.结论 先天性积水患儿肾脏AQPI-4蛋白表达下降,其表达量与肾实质厚度和肾脏GFR的变化呈正相关.%Objective To study the relationship of renal aquaporin -1, -2, -3, and -4 (AQP1-4) expression with renal parenchymal thickness and glomerular filtration rate ( GFR) in children with congenital hydronephrotis. Methods Renal tissue samples were obtained from 10 kidneys of 10 children (age; 62. 3 ± 18. 3 months) with hydronephrosis and who underwent Anderson-Hynes pyeloplasty. Renal control samples were obtained from 6 children ( age; 62. 7 ± 17. 1 months) undergoing nephrectomy for nephroblastoma and were confirmed histologically as normal renal tissues. Renal parenchymal thickness of the hydronephrotic kidneys was measured by ultrasound preoperatively and was verified at operation. Renal GFR was assessed using 99mTc-DTPA scintigraphy preoperatively. Western blot was used to examine the expression of AQP1-4 in the renal tissues. The correlations of renal AQP1-4 expression with the renal parenchymal thickness and GFR were

  16. Evaluation of renal graft haemodynamia by 51Cr-EDTA and o-[131I]iodohippurate: its use in the early diagnosis of glomerular hyperfiltration.

    Science.gov (United States)

    Estorch, M; Tembl, A; Antonijoan, R; Hernandez, A; Mari, C; Flotats, A; Camacho, V; Sola, R; Barbanoj, M; Carrio, I

    2003-06-01

    Chronic rejection is the most important cause of renal graft dysfunction. Non-immunological mechanisms have been suggested as a probable origin of chronic graft rejection, provoking a decrease in renal mass function, followed by glomerular hyperfiltration in the remnant nephrons, which could cause progressive glomerulosclerosis and functional loss. Early, or preclinical, identification of patients with glomerular hyperfiltration, defined as an increase in glomerular filtration fraction (GFF) and in glomerular capillary pressure (GCP), could prolong graft life. The objective of this study was to evaluate, non-invasively, stable renal graft haemodynamia and early glomerular hyperfiltration. We studied 116 renal transplant patients with stable renal function and five healthy living kidney donors with normal renal function. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined using 51Cr-EDTA and o-[131I]iodohippurate, respectively. GFF was obtained from the relation between GFR and ERPF, and GCP from a mathematical model (Hall-Gomez' formula). A simultaneous analysis of renal function was performed. In transplant patients, the GFR and ERPF were significantly lower than in healthy, living, kidney donors (PGFF was not significantly different. Twelve patients (10.3%) had criteria of glomerular hyperfiltration. In patients without criteria of glomerular hyperfiltration, plasma level and clearance of creatinine were 128+/-33 micromol.l-1 and 56+/-15 ml.min-1, respectively; and in those patients with glomerular hyperfiltration criteria were 108+/-18 micromol.l-1 (P=NS) and 83+/-24 ml.min-1 (P=0.002) respectively. It is concluded that determinations of GFR, ERPF, GFF and GCP allow non-invasive evaluation of renal graft haemodynamia and can be useful in the early detection of glomerular hyperfiltration.

  17. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Lannemyr, Lukas; Bragadottir, Gudrun; Krumbholz, Vitus; Redfors, Bengt; Sellgren, Johan; Ricksten, Sven-Erik

    2017-02-01

    Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l · min · m) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation was estimated from the renal oxygen extraction. Urinary N-acetyl-β-D-glucosaminidase was measured before, during, and after cardiopulmonary bypass. Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys, which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a seven-fold increase in the urinary N-acetyl-β-D-glucosaminidase/creatinine ratio. Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

  18. Validation of predictive equations for glomerular filtration rate in the Saudi population

    Directory of Open Access Journals (Sweden)

    Al Wakeel Jamal

    2009-01-01

    Full Text Available Predictive equations provide a rapid method of assessing glomerular filtration rate (GFR. To compare the various predictive equations for the measurement of this parameter in the Saudi population, we measured GFR by the Modification of Diet in Renal Disease (MDRD and Cockcroft-Gault formulas, cystatin C, reciprocal of cystatin C, creatinine clearance, reciprocal of creatinine, and inulin clearance in 32 Saudi subjects with different stages of renal disease. We com-pared GFR measured by inulin clearance and the estimated GFR by the equations. The study included 19 males (59.4% and 13 (40.6% females with a mean age of 42.3 ± 15.2 years and weight of 68.6 ± 17.7 kg. The mean serum creatinine was 199 ± 161 μmol/L. The GFR measured by inulin clearance was 50.9 ± 33.5 mL/min, and the estimated by Cockcroft-Gault and by MDRD equations was 56.3 ± 33.3 and 52.8 ± 32.0 mL/min, respectively. The GFR estimated by MDRD revealed the strongest correlation with the measured inulin clearance (r= 0.976, P= 0.0000 followed by the GFR estimated by Cockcroft-Gault, serum cystatin C, and serum creatinine (r= 0.953, P= 0.0000 (r= 0.787, P= 0.0001 (r= -0.678, P= 0.001, respectively. The reciprocal of cystatin C and serum creatinine revealed a correlation coefficient of 0.826 and 0.93, respectively. Cockroft-Gault for-mula overestimated the GFR by 5.40 ± 10.3 mL/min in comparison to the MDRD formula, which exhibited the best correlation with inulin clearance in different genders, age groups, body mass index, renal transplant recipients, chronic kidney disease stages when compared to other GFR predictive equations.

  19. Variability of glomerular filtration rate estimation equations in elderly Chinese patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Liu X

    2012-10-01

    Full Text Available Xun Liu,1,2,* Mu-hua Cheng,3,* Cheng-gang Shi,1 Cheng Wang,1 Cai-lian Cheng,1 Jin-xia Chen,1 Hua Tang,1 Zhu-jiang Chen,1 Zeng-chun Ye,1 Tan-qi Lou11Division of Nephrology, Department of Internal Medicine, The Third Affiliated Hospital of Sun Yet-sun University, Guangzhou, China; 2College of Biology Engineering, South China University of Technology, Guangzhou, China; 3Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yet-sun University, Guangzhou, China *These authors contributed equally to this paperBackground: Chronic kidney disease (CKD is recognized worldwide as a public health problem, and its prevalence increases as the population ages. However, the applicability of formulas for estimating the glomerular filtration rate (GFR based on serum creatinine (SC levels in elderly Chinese patients with CKD is limited.Materials and methods: Based on values obtained with the technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA renal dynamic imaging method, 319 elderly Chinese patients with CKD were enrolled in this study. Serum creatinine was determined by the enzymatic method. The GFR was estimated using the Cockroft–Gault (CG equation, the Modification of Diet in Renal Disease (MDRD equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equation, the Jelliffe-1973 equation, and the Hull equation.Results: The median of difference ranged from −0.3–4.3 mL/min/1.73 m2. The interquartile range (IQR of differences ranged from 13.9–17.6 mL/min/1.73 m2. Accuracy with a deviation less than 15% ranged from 27.6%–32.9%. Accuracy with a deviation less than 30% ranged from 53.6%–57.7%. Accuracy with a deviation less than 50% ranged from 74.9%–81.5%. None of the equations had accuracy up to the 70% level with a deviation less than 30% from the standard glomerular filtration rate (sGFR. Bland–Altman analysis demonstrated that the mean difference ranged from −3.0–2.4 mL/min/1.73 m2. However, the

  20. Comparación entre las ecuaciones CKD-EPI y MDRD para la estimación del filtrado glomerular en pacientes con enfermedad renal crónica Comparison between CKD-EPI and MDRD-equations to estimate glomerular filtration rate in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Guillermo J. Rosa-Diez

    2011-08-01

    Full Text Available La ecuación MDRD para la estimación del índice de filtrado glomerular (IFG, es la estrategia más utilizada para evaluar pacientes con enfermedad renal crónica (ERC. Sin embargo, puede subestimar el IFG con el riesgo de asignar al paciente a estadios más avanzados de ERC. La nueva ecuación CKD-EPI, mejoraría la exactitud y precisión de las estimaciones. Sus autores sugieren que reemplace a la anterior. No habiendo comparaciones de estas ecuaciones aplicadas en un gran número de pacientes en nuestro país, nuestro objetivo fue realizarla en una amplia cohorte de pacientes. Se evaluó la concordancia de asignación en estadios de ERC entre ambas ecuaciones, tomando como referencia los datos surgidos de MDRD. Se calculó la media de las diferencias de los IFG obtenidos empleando ambas ecuaciones y se aplicó el análisis estadístico de Bland-Altman. Se estudió una cohorte de 9 319 pacientes con una media de creatinina sérica de 1.60 ± 1.03 mg/dl, 67% de sexo femenino y edad media 58 ± 20 años. En el grupo total, CKD-EPI presentó una media de IFG 0.61 ml/min/1.73 m² mayor que MDRD (p: NS. En los estadios 2 y 3A las medias del IFG fueron respectivamente 6.95 ± 4.76 y 3.21 ± 3.31, y la concordancia de 81 y 74%. El porcentaje de pacientes con un IFG menor de 60 ml/min/1.73 m², se redujo de 76.3% (MDRD a 70.1% (CKD-EPI. Por lo tanto, la nueva ecuación CKD-EPI disminuye el número de pacientes con IFG debajo de 60 ml/min/1.73 m² y asigna estadios de IFG más elevado a un número mayor de pacientes.The MDRD equation to estimate glomerular filtration rate (GFR is the most widely used strategy to assess chronic kidney disease. Nonetheless, for the individual patient the true GFR can be underestimated with the risk of diagnosing a more elevated CKD stage. This novel CKD-EPI equation would improve accuracy and precision of estimations, and several authors recommend this new equation replace the former. In our country there is only a

  1. Important clinical and laboratory correlates of glomerular filtration ...

    African Journals Online (AJOL)

    2015-02-03

    Feb 3, 2015 ... The GFR was estimated using (isotope dilution mass spectrometry) traceable modification .... medical records of patients included demographic data; age, ... min/1.73 m2)[11] Preparation for renal replacement therapy.

  2. Sieve plugs in fenestrae of glomerular capillaries--site of the filtration barrier?

    DEFF Research Database (Denmark)

    Rostgaard, Jørgen; Qvortrup, Klaus

    2002-01-01

    The exact location of the filtration barrier of the glomerular capillary wall, which consists of an endothelium, a basement membrane and a visceral epithelium, has not yet been determined. Apparent discrepancies between different investigators in the past could be explained if postmortem artifact...

  3. Reliability of estimated glomerular filtration rate in patients treated with platinum containing therapy

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Gundgaard, Maria G; Mortensen, Mette S

    2014-01-01

    Estimates of glomerular filtration rate (eGFR) are widely used when administering nephrotoxic chemotherapy. No studies performed in oncology patients have shown whether eGFR can safely substitute a measured GFR (mGFR) based on a marker method. We aimed to assess the validity of four major formula...

  4. Decline in 51Cr-labelled EDTA measured glomerular filtration rate following lung transplantation

    DEFF Research Database (Denmark)

    Hornum, Mads; Burton, Christopher M; Iversen, Martin

    2007-01-01

    BACKGROUND: The nephrotoxity of calcineurin inhibitors in lung-transplanted patients is well described, but previous studies have estimated rather than directly measured glomerular filtration rate (GFR). This study describes the decline of measured GFR in a large cohort of lung-transplanted patie...

  5. Association between serum uric acid and different states of glucose metabolism and glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    CAI Xiao-ling; HAN Xue-yao; JI Li-nong

    2010-01-01

    Background Recently, it has been suggested that the serum uric acid (SUA) level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose metabolism and glomerular filtration rate (GFR) reflected by the simplified Modification of Diet in Renal Disease (MDRD) equation and to test the hypothesis that high MDRD is one of the determinants of SUA level.Methods This cross-sectional study included 2373 subjects in Beijing who underwent a 75 g oral glucose tolerance test (OGTT) for screening of diabetes. According to the states of glucose metabolism, they were divided into normal glucose tolerance, impaired glucose regulation and diabetes.Results Multiple stepwise linear regression analysis showed that adjusted by gender, SUA was positively correlated with body mass index (BMI), waist/hippo ratio, systolic blood pressure (SBP) and triglyceride, meanwhile negatively correlated with age, hemoglobin A1c, fasting insulin and MDRD. There was an increasing trend in SUA concentration and a decreasing trend in MDRD when the levels of fasting plasma glucose (FPG) increased from low to high up to the FPG level of 8.0 mmol/L; thereafter, the SUA concentration started to decrease with further increases in FPG levels, and the MDRD started to increase with further increases in FPG levels.Conclusion This study confirmed the previous finding that SUA decreased in diabetes and provided the supporting evidence that the increased MDRD might contribute to the fall of SUA.

  6. Comparison between Cockcroft-Gault and MDRD formulas to estimated glomerular filtration rate in diabetic people

    Directory of Open Access Journals (Sweden)

    María Elena Romero Y.

    2013-04-01

    Full Text Available INTRODUCTION: Diabetic Nephropathy is a significant complication of Diabetes Mellitus. That’s why, the American Diabetes Association (ADA recommended for screening the determination of the glomerular filtration rate (GFR. MDRD (Modification of Diet in Renal Disease, is a formula which allows a very exactly estimation of GFR. Permanently, it had always been compared with Cockcroft-Gault formula. OBJECTIVE: Compare both formulas in the local reality. MATERIAL AND METHOD: It was done a retrospective studio over 243 patients, randomly selected, of a total of 1,057 type 2 diabetes patients registered in Cardiovascular program of San Rafael CESFAM that had serial measurement of plasmatic creatinine in their periodic controls. It was considered the most recent values of plasmatic creatinine taken between January 2010 – October 2011. RESULTS: Of the patients selected, 158 women (65% and 85 men (35%, with average age of 53 years (SD 8,08, the GFR estimated with MDRD was of 89 ml/min/1.73 m2 (SD 21 and 108 ml/min (SD 32 for Cockcroft-Gault formula, p<0.001. We realized a correlation studio between both formulas. DISCUSSION: Both formulas demonstrated an acceptable correlation to estimated GFR, although obese patients had higher estimations with Cockcroft-Gault formula, on the other side, elderly patients had elevated results with MDRD.

  7. Correlation between glomerular filtration rate and urinary N acetyl-beta-D glucosaminidase in children with persistent proteinuria in chronic glomerular disease

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    Jeong Deok Hong

    2012-04-01

    Full Text Available Purpose: Urinary excretion of N acetyl-beta-D glucosaminidase (NAG and ?#11437;microglobulin (?#11437;M was increased in the presence of proximal tubular damage. Based on these urinary materials, we investigated the ability of expecting renal function in chronic glomerular diseases. In this study, we evaluated the relationship between glomerular filtration rate (GFR urinary NAG, and urinary ?#11437;M. Methods: We evaluated 52 children with chronic kidney disease at the Chung-Ang University Hospital between January 2003 and August 2009. We investigated the 24-hour urinalysis and hematologic values in all 52 patients. Serum creatinine, creatinine clearance (Ccr, serum cystatin C, urinary ?#11437;M and urinary NAG were measured. Results: Out of 52 patients, there were 13 children with minimal change in disease, 3 children with focal segmental glomerulosclerosis, 17 children with immunoglobulin A nephropathy, 15 children with Henoch-Schonlein purpua nephritis, 3 children with poststreptococcal glomerulonephritis, and 1 child with thin glomerular basement membrane disease. In these patients, there were significant correlation between the Ccr and urinary NAG (r=-0.817; P&lt;0.01, and between the GFR (as determined by Schwartz method and urinary NAG (r=- 0.821; P&lt;0.01. In addition, there was a significant correlation between the GFR (as determined by Bokencamp method and urinary NAG (r=- 0.858; P&lt;0.01. Conclusion: In our study, there was a significant correlation between the GFR and urinary NAG, but there was no correlation between the GFR and urinary ?#11437;M, suggesting that the GFR can be predicted by urinary NAG in patients with chronic glomerular disease.

  8. The clinical significance of glomerular filtration rate measured by 99Tcm-diethylentriamine pentaacetic acid renal dynamic imaging in renal cercinoma patients before surgeru%99Tcm-DTPA法肾小球滤过率在肾癌患者术前肾功能评价中的临床意义

    Institute of Scientific and Technical Information of China (English)

    邵小南; 王跃涛; 王小松; 陈海龙

    2011-01-01

    Objective To investigate the clinical significance of glomerular filtration rate(GFR)measured by 99Tcm-diethylenetriamine pentaacetic acid(99Tcm-DTPA)renal dynamic imaging in renal cell carcinoma(RCC)patients before surgery.Methods There were 99 cases of RCC patients,89 patients undergoing radical nephrectomy(RN)and 10 patients undergoing nephron-sparing surgery(NSS).99Tcm-DTPA renal dynamic imaging was performed for determining GFR before surgery.Make a comparison of GFR between RCC group and control group (normal kidney donors),RN group and NSS group.Make a comparison between GFR and serum creatinine in determining preoperative renal dysfunction of RCC patients.All of the data were analyzed by t-test and X2-text.Results Compared with contral group,total GFR of RCC patients was lower,but there was no significant difference[(76.4±20.4)ml/min vs.(80.6±17.4)ml/min,t=0.650,P>0.05)].Nineteen cases(19.2%)of RCC patients had preoperative renal dysfunction(total GFR133μmol/L).There was no significant difference in GFR of neoplastic kidneys between RN group and NSS group[(34.1±11.7)ml/min vs.(37.9±11.9)ml/min,t=0.975,P>0.05].GFR of contralateral kidneys was lower in NSS group than RN group[(32.7±10.3)ml/min vs.(39.6±10.1)ml/min,t=0.044,P0.05).19例(19.2%)RCC患者术前存在肾功能异常(双肾GFR133 μmol/L)者仅4例.RCC患者中,NSS组患侧肾脏GFR与RN组相比,差异无统计学意义[(34.1±11.7)ml/min vs.(37.9±11.9)ml/min,t=0.975,P>0.05],对侧肾脏GFR低于RN组[(32.7±10.3)ml/min vs.(39.6±10.1)ml/min,t=0.044,P<0.05],NSS组术前肾功能异常者比例明显高于RN组(50.0%vs.15.7%,X2=6.808,P<0.01 )结论 99Tcm-DTPA法测定的GFR能获得RCC患者术前双肾和分肾功能的准确信息,对RCC患者的治疗决策有重要意义.

  9. Hemodinâmica glomerular renal no roedor Calomys callosus

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    Mirian A. Boim

    1989-03-01

    Full Text Available A função renal do roedor Calomys callosus, envolvido no ciclo de transmissão de diversos agentes patogênicos para o homem foi avaliada no animal intacto, através da técnica de depuração e micropunção renal. Os resultados mostraram que este roedor apresenta níveis pressóricos, hematócrito e proteinas plasmáticas semelhantes aos dos ratos submetidos ao mesmo procedimento experimental. Os pesos corporal e renal, bem como a filtração glomerular global e por nefro assemelham-se aos do camundongo. Surpreendentemente estes roedores apresentaram significante número de glomérulos superficiais por rim, permitindo a avaliação da hemodinàmica glomerular. Apesar da pressão arterial semelhante à dos ratos Munich-Wistar (MW, a pressão hidráulica intraglomerular no Calomys callosus foi inferior. Esta redução foi conseqüente à menor resistência pós-glomerular quando comparada à dos ratos MW. O fluxo plasmático glomerular atingiu valor bastante elevado em relação à filtração glomerular por nefro, fato que não só compensaria a reduzida pressão intraglomerular, como também seria suficiente para elevar a filtração (por g/rim a níveis superiores neste roedor, pois o coeficiente de ultrafiltração glomerular (Kj foi semelhante ao do rato MW. O presente trabalho sugere que apesar das dificuldades técnicas que este animal impõe devido ao seu reduzido tamanho, o estudo da função renal global bem como da hemodinàmica glomerular é factível, podendo portanto ser utilizado como modelo para estudo da função renal em doenças tropicais.

  10. Automating and estimating glomerular filtration rate for dosing medications and staging chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Trinkley KE

    2014-05-01

    Full Text Available Katy E Trinkley,1 S Michelle Nikels,2 Robert L Page II,1 Melanie S Joy11Skaggs School of Pharmacy and Pharmaceutical Sciences, 2School of Medicine, University of Colorado, Aurora, CO, USA Objective: The purpose of this paper is to serve as a review for primary care providers on the bedside methods for estimating glomerular filtration rate (GFR for dosing and chronic kidney disease (CKD staging and to discuss how automated health information technologies (HIT can enhance clinical documentation of staging and reduce medication errors in patients with CKD.Methods: A nonsystematic search of PubMed (through March 2013 was conducted to determine the optimal approach to estimate GFR for dosing and CKD staging and to identify examples of how automated HITs can improve health outcomes in patients with CKD. Papers known to the authors were included, as were scientific statements. Articles were chosen based on the judgment of the authors.Results: Drug-dosing decisions should be based on the method used in the published studies and package labeling that have been determined to be safe, which is most often the Cockcroft–Gault formula unadjusted for body weight. Although Modification of Diet in Renal Disease is more commonly used in practice for staging, the CKD–Epidemiology Collaboration (CKD–EPI equation is the most accurate formula for estimating the CKD staging, especially at higher GFR values. Automated HITs offer a solution to the complexity of determining which equation to use for a given clinical scenario. HITs can educate providers on which formula to use and how to apply the formula in a given clinical situation, ultimately improving appropriate medication and medical management in CKD patients.Conclusion: Appropriate estimation of GFR is key to optimal health outcomes. HITs assist clinicians in both choosing the most appropriate GFR estimation formula and in applying the results of the GFR estimation in practice. Key limitations of the

  11. A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients.

    Science.gov (United States)

    Dong, Kai; Huang, Xiaoqin; Zhang, Qian; Yu, Zhipeng; Ding, Jianping; Song, Haiqing

    2017-02-01

    Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (stroke patients. A low baseline eGFR was also a strong independent predictor for newly ischemic events in ICAS patients.

  12. Glomerular endothelial surface layer acts as a barrier against albumin filtration.

    Science.gov (United States)

    Dane, Martijn J C; van den Berg, Bernard M; Avramut, M Cristina; Faas, Frank G A; van der Vlag, Johan; Rops, Angelique L W M M; Ravelli, Raimond B G; Koster, Bram J; van Zonneveld, Anton Jan; Vink, Hans; Rabelink, Ton J

    2013-05-01

    Glomerular endothelium is highly fenestrated, and its contribution to glomerular barrier function is the subject of debate. In recent years, a polysaccharide-rich endothelial surface layer (ESL) has been postulated to act as a filtration barrier for large molecules, such as albumin. To test this hypothesis, we disturbed the ESL in C57Bl/6 mice using long-term hyaluronidase infusion for 4 weeks and monitored albumin passage using immunolabeling and correlative light-electron microscopy that allows for complete and integral assessment of glomerular albumin passage. ESL ultrastructure was visualized by transmission electron microscopy using cupromeronic blue and by localization of ESL binding lectins using confocal microscopy. We demonstrate that glomerular fenestrae are filled with dense negatively charged polysaccharide structures that are largely removed in the presence of circulating hyaluronidase, leaving the polysaccharide surfaces of other glomerular cells intact. Both retention of native ferritin [corrected] in the glomerular basement membrane and systemic blood pressure were unaltered. Enzyme treatment, however, induced albumin passage across the endothelium in 90% of glomeruli, whereas this could not be observed in controls. Yet, there was no net albuminuria due to binding and uptake of filtered albumin by the podocytes and parietal epithelium. ESL structure and function completely recovered within 4 weeks on cessation of hyaluronidase infusion. Thus, the polyanionic ESL component, hyaluronan, is a key component of the glomerular endothelial protein permeability barrier.

  13. Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients.

    Science.gov (United States)

    Hojs Fabjan, Tanja; Penko, Meta; Hojs, Radovan

    2014-02-01

    Renal dysfunction is associated with mortality in patients after ischemic stroke. Cystatin C is a potentially superior marker of renal function compared to creatinine and estimated glomerular filtration rate (GFR). In our observational cohort study, 390 Caucasian patients suffered from acute ischemic stroke (mean age 70.9 years; 183 women and 207 men) were included and prospectively followed up to maximal 56 months. Serum creatinine and cystatin C were measured at admission to the hospital; GFR was estimated according to CKD-EPI creatinine and CKD-EPI creatinine/cystatin equations. According to values of serum creatinine, estimated GFR and serum cystatin C patients were divided into quintiles. In the follow-up period, 191 (49%) patients died. For serum cystatin C and estimated GFR based on creatinine and cystatin C, the mortality and the hazard ratios for long-term mortality increased from the first to the fifth quintile nearly linearly. The associations of serum creatinine and estimated GFR categories based on creatinine with long-term mortality were J-shaped. As compared with lowest quintile of serum cystatin C, the fifth quintile was associated with long-term mortality significantly also after multivariate adjustment (age, gender, initial stroke severity, known risk factors for stroke mortality). In contrast, in adjusted analysis serum creatinine and estimated GFR (CKD-EPI creatinine and CKD-EPI creatinine/cystatin) were not associated with long-term mortality. In summary, serum cystatin C was independently and better associated with the risk of long-term mortality in patients suffering from ischemic stroke than were creatinine and estimated GFR using both CKD-EPI equations.

  14. Proenkephalin, Neutrophil Gelatinase-Associated Lipocalin, and Estimated Glomerular Filtration Rates in Patients With Sepsis.

    Science.gov (United States)

    Kim, Hanah; Hur, Mina; Lee, Seungho; Marino, Rossella; Magrini, Laura; Cardelli, Patrizia; Struck, Joachim; Bergmann, Andreas; Hartmann, Oliver; Di Somma, Salvatore

    2017-09-01

    Proenkephalin (PENK) has been suggested as a novel biomarker for kidney function. We investigated the diagnostic and prognostic utility of plasma PENK in comparison with neutrophil gelatinase-associated lipocalin (NGAL) and estimated glomerular filtration rates (eGFR) in septic patients. A total of 167 septic patients were enrolled: 99 with sepsis, 37 with septic shock, and 31 with suspected sepsis. PENK and NGAL concentrations were measured and GFR was estimated by using the isotope dilution mass spectrometry traceable-Modification of Diet in Renal Disease (MDRD) Study and three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations: CKD-EPI(Cr), CDK-EPI(CysC), and CKD-EPI(Cr-CysC). The PENK, NGAL, and eGFR results were compared according to sepsis severity, presence or absence of acute kidney injury (AKI), and clinical outcomes. The PENK, NGAL, and eGFR results were significantly associated with sepsis severity and differed significantly between patients with and without AKI only in the sepsis group (all P<0.05). PENK was superior to NGAL in predicting AKI (P=0.022) and renal replacement therapy (RRT) (P=0.0085). Regardless of the variable GFR category by the different eGFR equations, PENK showed constant and significant associations with all eGFR equations. Unlike NGAL, PENK was not influenced by inflammation and predicted the 30-day mortality. PENK is a highly sensitive and objective biomarker of AKI and RRT and is useful for prognosis prediction in septic patients. With its diagnostic robustness and predictive power for survival, PENK constitutes a promising biomarker in critical care settings including sepsis.

  15. Importance of urinary NGAL, serum creatinine standardization and estimated glomerular filtration rate in resistant hypertension.

    Science.gov (United States)

    Prkacin, Ingrid; Ozvald, Ivan; Cavrić, Gordana; Balenović, Diana; Bulum, Tomislav; Flegar-Mestrić, Zlata

    2013-09-01

    In patients with resistant hypertension (RH) we investigated the importance of urinary neutrophil gelatinase-associated lipocalin (uNGAL- a chemiluminescent microparticle immunoassay (CMIA) method became using (Abbott Diagnostics) for the measurement of NGAL in urine samples) and incidence of chronic kidney disease using the Modification of Diet in Renal Disease Study (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in estimating glomerular filtration rate (eGFR) based on standardised serum creatinine method traceable to isotope dilution mass spectrometry (IDMS) method. It would have been difficult to predict that levels of these biomarker would perform better organ damage than traditional measurements of kidney function such as standardised serum creatinine, MDRD, or CKD-EPI equations in special population such as RH. Serum creatinine concentrations were measured in 50 patients (24M:26F from RH Registar in Clinical Hospital Merkur) by the kinetic Jaffe method. There were no significant differences between the GFR values derived by MDRD and CKD-EPI equations in the group of patients with RH. 62% of patients have eGFR > 60 mL/minl/1.73 m2, while a 38% of patients have eGFR < 60 mL/min/1.73 m2. The measurement of NGAL in urine samples of 40 patients with RH showed no difference and seems to be of no use in further determination of renal impairement. Higher value of uNGAL in some resistant hypertension patients could have link in the repair stage after AKI and would reveal pathways that could link AKI and CKD.

  16. Functional evaluation of hydronephrosis by diffusion-weighted MR imaging: Relationship between apparent diffusion coefficient and split glomerular filtration rate

    Energy Technology Data Exchange (ETDEWEB)

    Toyoshima, S.; Noguchi, K.; Seto, H.; Shimizu, M.; Watanabe, N. [Toyama Medical and Pharmaceutical Univ. (Japan). Dept. of Radiology

    2000-11-01

    To determine the relationship between apparent diffusion coefficient (ADC) values measured by diffusion-weighted MR imaging and split renal function determined by renal scintigraphy in patients with hydronephrosis. Material and Methods: Diffusion-weighted imaging on a 1.5 T MR unit and renal scintigraphy were performed in 36 patients with hydronephrosis (45 hydronephrotic kidneys, 21 non-hydronephrotic kidneys). ADC values of the individual kidneys were measured by diffusion-weighted MR imaging. Split renal function (glomerular filtration rate (GFR)) was determined by renal scintigraphy using {sup 99m}Tc-DTPA. The relationship between ADC values and split GFR was examined in 66 kidneys. The hydronephrotic kidneys were further classified into three groups (severe renal dysfunction, GFR <10 ml/min, n=7; moderate renal dysfunction, GFR 10-25 ml/min, n=10; normal renal function, GFR >25 ml/min, n=28), and mean values for ADCs were calculated. Results: In hydronephrotic kidneys, there was a moderate positive correlation between ADC values and split GFR (R2=0.56). On the other hand, in non-hydronephrotic kidneys, poor correlation between ADC values and split GFR was observed (R2=0.08). The mean values for ADCs of the dysfunctioning hydronephrotic kidneys (severe renal dysfunction, 1.32x10{sup -3}{+-}0.18x10{sup -3} mm{sup 2}/s; moderate renal dysfunction, 1.38x10{sup -3}{+-}0.10x10{sup -3} mm2/s) were significantly lower than that of the normal functioning hydronephrotic kidneys (1.63x10{sup -3}{+-}0.12{+-}10{sup -3} mm{sup 2}/s). Conclusion: These results indicated that measurement of ADC values by diffusion-weighted MR imaging has a potential value in the evaluation of the functional status of hydronephrotic kidneys.

  17. Short-term inhibition of prostaglandin synthesis has no effect on the elevated glomerular filtration rate of early insulin-dependent diabetes

    DEFF Research Database (Denmark)

    Christiansen, J S; Feldt-Rasmussen, B; Parving, H H

    1985-01-01

    Glomerular filtration rate and renal plasma flow (constant infusion technique using 125I-iothalamate and 131I-hippuran) were measured twice within a 1-week interval in nine young males with insulin-dependent diabetes of short duration (2-5 years). The study was performed in a randomized double......-blind design, with the patients receiving either indomethacin (150 mg/day) or placebo for 3 days before the study. Measures of metabolic control did not change. No differences were found in glomerular filtration rate (144 +/- 9 versus 144 +/- 9 ml/min X 1.73 m2, mean +/- S.E.M.) or renal plasma flow (579...... +/- 43 versus 560 +/- 52 ml/min X 1.73 m2), when measured during placebo or indomethacin treatment, respectively. It is concluded that the steady-state enhancement of glomerular filtration rate and renal plasma flow found in early insulin-dependent diabetes is not due to an excessive activity...

  18. Theoretical comparison of filtration by the renal glomerulus and artificial membranes.

    Science.gov (United States)

    Tsuji, M; Sakai, K

    1999-01-01

    Improvement in filtration performance of artificial membranes will be possible if their structure mimics the renal glomerulus. Blood filtration with glomerular capillary and artificial membranes was, therefore, modeled to clarify the effects of their structure on filtration rates. Filtration rates were obtained by dividing membrane modules axially into a number of sections and using a calculus of finite differences. The modules were assumed to be composed of straight hollow fibers arranged in parallel, with a membrane surface area of 1.5 m2. The mean transmembrane pressure (TMP) was assumed to be too low for a protein gel layer to form on the membrane surface. A decrease in the inner diameter of membrane hollow fibers led to an increase in filtration rate because of an increased film mass transfer coefficient. A decrease in hollow fiber length also produced an increase in filtration rate because of decreased axial TMP drop. The glomerular capillary has a higher filtration rate than artificial membranes because of the low TMP drop and the low osmotic pressure at the membrane surface. Decreasing both the inner diameter and the length of the hollow fibers is effective in increasing the filtration rate at constant TMP.

  19. Longitudinal association between serum leptin concentration and glomerular filtration rate in humans.

    Directory of Open Access Journals (Sweden)

    Claudio Pedone

    Full Text Available Obesity is a risk factor for decline in glomerular filtration rate (GFR. One proposed mechanism leading to glomerulopathy is an increase in leptin levels. However, the association between leptin and GFR has never been demonstrated. The aim of this study is to verify whether higher levels of leptin are associated with longitudinal changes of estimated GFR (eGFR.We selected 744 participants in the InCHIANTI study (416 women. The association between eGFR and leptin changes over a 6-years follow-up was assessed using random effect models including leptin as a time-varying covariate and adjusted for potential confounders. We also compared the proportion of patients with rapid decline of renal function across tertiles of change in serum leptin between baseline and 6-years follow-up. Mean baseline eGFR was 82.2 ml/min/1.73 m, 78.7 ml/min/1.73 m, and 75.4 ml/min/1.73 m in the first, second and third tertile of baseline serum leptin concentration, respectively. After adjustment for potential confounders, leptin concentration was inversely associated with changes of eGFR over time (β for log-leptin: -1.288, 95% CI: -2.079 - -0.497. Relative to baseline levels, the estimated change in eGFR for unit-increase in log-leptin was -1.9% (95% CI: -2.977 - -0.761. After stratification by sex, the results were confirmed in women only. In women we also found an association between increasing leptin concentration over time and rapid decline of renal function.In women, serum leptin may contribute to eGFR decline independently from obesity and diabetes mellitus, although a cause-effect relationship cannot be established due to the observational nature of our study. A better characterization of adipokine profile of obese individuals may shed light on the accelerated renal function decline reported in a proportion of high-risk obese individuals.

  20. Glomerular filtration rate in examined population of Bosnian Posavina - region of Balkan Endemic Nephropathy.

    Science.gov (United States)

    Alecković, Mirna; Mesić, Enisa; Trnacević, Senaid; Stipancić, Zelimir; Hamidović, Damir; Hasanović, Evlijana

    2010-04-01

    Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular filtration rate (GFR), is assumed a marker of overall renal function. The aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region. Study included 603 inhabitants of Bosnian Posavina, out of whom 386 (65%) from endemic (Domaljevac) and 217 (36%) from non-endemic (Svilaj) village, and it was performed in two phases. The first phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specific gravity, pH, proteins, leukocytes, glucose, ketones, and microalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (5th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (603), 145 examinees were included in the second phase. After exclusion of 17 diabetic patients, 94 (73%) examinees from endemic and 34 (27%) examinees from non-endemic region remained. In the endemic region there were 46 (49%) examinees with and 48 (51%) without family burden for BEN. Overall GFR in examined groups was within

  1. Impaired autoregulation of glomerular filtration rate in type 1 (insulin-dependent) diabetic patients with nephropathy

    DEFF Research Database (Denmark)

    Parving, H H; Kastrup, Helge; Smidt, U M

    1984-01-01

    The effect of acute lowering of arterial blood pressure upon kidney function in nephropathy was studied in 13 patients with long-term Type 1 (insulin-dependent) diabetes. Ten normal subjects (six normotensive and four hypertensive) and five short-term Type 1 diabetic patients without nephropathy...... micrograms) or saline (0.154 mmol/l). The arterial blood pressure was similar in the diabetic patients with nephropathy (mean 136 +/- 11 divided by 88 +/- mmHg) and in the non-diabetic control subjects (mean 140 +/- 25 divided by 92 +/- 15 mmHg). The clonidine injection induced similar reductions in mean...... excretion declined from 1707 to 938 micrograms/min (p less than 0.01) in the patients with diabetic nephropathy. Our results suggest that an intrinsic vascular (arteriolar) mechanism underlying the normal autoregulation of glomerular filtration rate, i.e. the relative constancy of glomerular filtration rate...

  2. Obesity in kidney transplant recipients: association with decline in glomerular filtration rate.

    Science.gov (United States)

    Moreira, Thaís Rodrigues; Bassani, Tayron; de Souza, Gizele; Manfro, Roberto Ceratti; Gonçalves, Luiz Felipe Santos

    2013-10-01

    In this study we aimed to evaluate the influence of obesity in kidney and patient survival and graft function. Retrospective cohort study of kidney transplant recipients performed between 2001 and 2009. The body mass index was calculated at time of transplantation, one and five years after. The main outcomes studied were incidence of delayed graft function, new onset diabetes after transplantation, patient and graft survival, and glomerular filtration rate. The prevalence of obesity and overweight patients were 10.7% and 26.8% respectively, with an increase to 16.9% and 32.5% one year after transplantation. Underweight and obese recipients presented a higher incidence of early graft loss. The incidence of new onset diabetes after transplantation was significantly higher at one and five years in overweight or obese recipients at baseline. Overweight and obese recipients presented significantly lower estimated glomerular filtration rate at five years posttransplantation (p = 0.002). In the Kaplan-Meier analyses no statistically significant differences in patients or grafts survivals were observed. Obese patients have a higher rate of early graft failure and a higher new onset diabetes after transplantation incidence. Also, the finding of decreased glomerular filtration rate is worrisome and perhaps longer follow-up will reveal more graft failures and patients deaths in the group of obese recipients.

  3. Application value of the radionuclide renal dynamic imaging in measuring glomerular filtration rate in patients with cervical cancer chemotherapy%核素肾动态显像测定GFR在宫颈癌患者化疗中的应用价值

    Institute of Scientific and Technical Information of China (English)

    黄清霞; 李春英; 邹金海; 梁育飞; 张庆峰

    2012-01-01

    目的 探讨核素肾动态显像测定肾小球率过滤(GFR)在宫颈癌患者化疗中的应用价值.方法 选择我院2009年1月~2012年4月收治的宫颈癌患者233例,在化疗前及化疗3个周期后应用99锝-二乙三胺五乙酸(99Tcm-DTPA)进行肾动态显像,根据GFR、Tb、C1/2是否超出正常范围为标准,分为异常组70例及正常组163例,分别比较化疗前及化疗3个周期后两组核素肾动态显像结果.结果 异常组70例患者化疗3个周期后与化疗前比较GFR明显下降,差异有高度统计学意义(P < 0.01),肾动态显像主要特点表现为双肾血流灌注峰值下降,Tb及C1/2延长,差异有统计学意义(P < 0.05),而BUN、SCr等指标化疗前后变化均不明显,差异无统计学意义(P > 0.05).结论 99Tcm-DTPA肾动态显像可敏感的监测宫颈癌患者化疗后GFR及早期肾功能损伤.%Objective To investigate the application value of the radionuclide renal dynamic imaging in measuring glomeru-lar filtration rate (GFR) in patients with cervical cancer chemotherapy. Methods 233 patients with cervical cancer in our hospital from January 2009 to April 2012 were collected, 99Tcm-DTPA was used in radionuclide renal dynamic imaging before and 3 periods after chemotherapy. According to the value of GFR, Tb, C1/2, 233 cases were divided into 70 cases of abnormal group and 163 cases of normal group, nuclide renal dynamic imaging results were compared in the two groups before and 3 periods after chemotherapy. Results GFR of 70 cases in abnormal group before and 3 periods after chemotherapy were markedly reduced, the difference were statistically significant (P 0.05). Conclusion The application value of the radionuclide renal dynamic imaging with 99Tcm-DTPA in measuring glomerular filtration rate and early damage of kidney in patients with cervical cancer chemotherapy is sensitive.

  4. Over-estimation of glomerular filtration rate by single injection [51Cr]EDTA plasma clearance determination in patients with ascites

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Brøchner-Mortensen, J; Malchow-Møller, A;

    1980-01-01

    The total plasma (Clt) and the renal plasma (Clr) clearances of [51Cr]EDTA were determined simultaneously in nine patients with ascites due to liver cirrhosis. Clt (mean 78 ml/min, range 34-115 ml/min) was significantly higher than Clr (mean 52 ml/min, range 13-96 ml/min, P .... To assess glomerular filtration rate in presence of ascites, the renal plasma clearance of [51Cr]EDTA should be used instead of the total plasma clearance....

  5. Pentosidine levels in nonproteinuric diabetes associated with both low estimated glomerular filtration rate and cataract

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    Lim XL

    2012-06-01

    Full Text Available Xiu-Li Lim,1,* Boon-Wee Teo,2,* Bee-Choo Tai,1 Tien Y Wong,3 Daniel P-K Ng1 1Department of Epidemiology and Public Health, 2Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, 3Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore*Joint first authorsBackground: The main objective of this study was to investigate whether plasma pentosidine levels were associated with cataract and low estimated glomerular filtration rate (eGFR in nonproteinuric type 2 diabetic patients.Methods: We characterized 888 nonproteinuric type 2 diabetic patients residing in Singapore according to their eGFR values. Proteinuria was excluded on the basis of multiple urinalyses. Patients with low renal function (cases, n = 125 and controls (n = 763 were defined as having eGFR < and ≥60 mL/min/1.73 m2, respectively. Pentosidine levels were measured by enzyme-linked immunosorbent assay. Multinomial logistic regression was used to test the association between plasma pentosidine levels and the joint phenotype of cataract and low eGFR.Results: Cases had higher triacylglycerol values, higher systolic blood pressure, and were more likely to be treated with two or more antihypertensive medications. In univariate analysis, cases were potentially more than twice as likely to have had a history of cataract compared with controls. This association persisted in multivariate analyses after adjusting for the significant covariates, hypertension and triacylglycerol, but was attenuated when age was included in the model. Plasma pentosidine levels were significantly higher in cases with low eGFR who also had a history of cataract. This association persisted in multivariate analyses that included the covariates, glycosylated hemoglobin, hypertension, and diabetic retinopathy, as well as age.Conclusion: Carbonyl stress, as reflected by pentosidine levels, is present in a subset of nonproteinuric diabetic patients

  6. How reliable is estimation of glomerular filtration rate at diagnosis of type 2 diabetes?

    Science.gov (United States)

    Chudleigh, Richard A; Dunseath, Gareth; Evans, William; Harvey, John N; Evans, Philip; Ollerton, Richard; Owens, David R

    2007-02-01

    The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations previously have been recommended to estimate glomerular filtration rate (GFR). We compared both estimates with true GFR, measured by the isotopic (51)Cr-EDTA method, in newly diagnosed, treatment-naïve subjects with type 2 diabetes. A total of 292 mainly normoalbuminuric (241 of 292) subjects were recruited. Subjects were classified as having mild renal impairment (group 1, GFR /=90 ml/min per 1.73 m(2)). Estimated GFR (eGFR) was calculated by the CG and MDRD equations. Blood samples drawn at 44, 120, 180, and 240 min after administration of 1 MBq of (51)Cr-EDTA were used to measure isotopic GFR (iGFR). For subjects in group 1, mean (+/-SD) iGFR was 83.8 +/- 4.3 ml/min per 1.73 m(2). eGFR was 78.0 +/- 16.5 or 73.7 +/- 12.0 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -11.1 to -0.6 using CG and -14.4 to -7.0 using MDRD. Ninety-five percent limits of agreement (mean bias +/- 2 SD) were -37.2 to 25.6 and -33.1 to 11.7, respectively. In group 2, iGFR was 119.4 +/- 20.3 ml/min per 1.73 m(2). eGFR was 104.4 +/- 26.3 or 92.3 +/- 18.7 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -17.4 to -12.5 using CG and -29.1 to -25.1 using MDRD. Ninety-five percent limits of agreement were -54.4 to 24.4 and -59.5 to 5.3, respectively. In newly diagnosed type 2 diabetic patients, particularly those with a GFR >/=90 ml/min per 1.73 m(2), both CG and MDRD equations significantly underestimate iGFR. This highlights a limitation in the use of eGFR in the majority of diabetic subjects outside the setting of chronic kidney disease.

  7. Stable glomerular filtration rate in normotensive IDDM patients with stable microalbuminuria. A 5-year prospective study

    DEFF Research Database (Denmark)

    Mathiesen, E R; Feldt-Rasmussen, B; Hommel, E

    1997-01-01

    OBJECTIVE: To investigate the long-term course of glomerular filtration rate (GFR) in IDDM patients with microalbuminuria in order to identify patients with stable or declining kidney function over a 5-year study. RESEARCH DESIGN AND METHODS: Forty normotensive (129 +/- 11/80 +/- 8 mmHg) IDDM...... min-1.1 x 73 m-2. RESULTS: Using multiple regression analysis, the rate of decline in GFR was independently correlated to onset of diabetic nephropathy (P ... x min-1 x year-1; NS). The difference in the rate of decline of GFR was significant (mean 2.7 ml x min-1 x year-1; P

  8. Glomerular filtration is reduced by high tidal volume ventilation in an in vivo healthy rat model

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    A. Luque

    2009-11-01

    Full Text Available Mechanical ventilation has been associated with organ failure in patients with acute respiratory distress syndrome. The present study examines the effects of tidal volume (V T on renal function using two V T values (8 and 27 mL/kg in anesthetized, paralyzed and mechanically ventilated male Wistar rats. Animals were randomized into two groups of 6 rats each: V T8 (V T, 8 mL/kg; 61.50 ± 0.92 breaths/min; positive end-expiratory pressure, 3.0 cmH2O; peak airway pressure (PAW, 11.8 ± 2.0 cmH2O, and V T27 (V T, 27 mL/kg; 33.60 ± 1.56 breaths/min; positive end-expiratory pressure, none, and PAW, 22.7 ± 4.0 cmH2O. Throughout the experiment, mean PAW remained comparable between the two groups (6.33 ± 0.21 vs 6.50 ± 0.22 cmH2O. For rats in the V T27 group, inulin clearance (mL·min-1·body weight-1 decreased acutely after 60 min of mechanical ventilation and even more significantly after 90 min, compared with baseline values (0.60 ± 0.05 and 0.45 ± 0.05 vs 0.95 ± 0.07; P < 0.001, although there were no differences between groups in mean arterial pressure or gasometric variables. In the V T8 group, inulin clearance at 120 min of mechanical ventilation remained unchanged in relation to baseline values (0.72 ± 0.03 vs 0.80 ± 0.05. The V T8 and V T27 groups did not differ in terms of serum thiobarbituric acid reactive substances (3.97 ± 0.27 vs 4.02 ± 0.45 nmol/mL or endothelial nitric oxide synthase expression (94.25 ± 2.75 vs 96.25 ± 2.39%. Our results show that glomerular filtration is acutely affected by high tidal volume ventilation but do not provide information about the mechanism.

  9. Association of CYBA rs7195830 polymorphism with estimated glomerular filtration rate in an adult Han sample from Jiangsu province, China

    Institute of Scientific and Technical Information of China (English)

    FAN Kuan-lu; ZHANG Hai-feng; ZHU Zhen-yan; YAO Wen-ming; SHEN Jie; LIANG Ning-xia; GONG Lei

    2013-01-01

    Background Reactive oxygen species are thought to contribute to the development of renal damage.The P22phox subunit of nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase,encoded by the cytochrome b245α polypeptide gene,CYBA,plays a key role in superoxide anion production.We investigated the association of CYBA rs7195830 polymorphism with estimated glomerular filtration rate (eGFR) and the role it plays in the pathogenesis of chronic kidney disease (CKD) in a Han Chinese sample.Methods The Gaoyou study enrolled 4473 participants.Serum levels of creatinine were measured and eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equations.The CYBA polymorphisms were genotyped.Then we investigated the association between eGFR and the rs7195830 polymorphism in the recessive model.Results The AA genotype of rs7195830 was associated with significantly lower values of eGFR compared with the GG and AG genotypes ((102.76±17.07) ml·min-1·1.73 m2 vs.(105.08±16.30) ml·min-1·1.73 m-2).The association remained significant in the recessive model after adjusting for age,gender,body mass index,smoking,hypertension,diabetes mellitus,uric acid,triglyceride,low density lipoprotein cholesterol and high density lipoprotein cholesterol (β=1.666,P=0.031).The rs7195832 AA genotype was an independent risk factor for CKD:eGFR <60 ml·min-1·1.73 m2 (odds ratio=3.32; 95% C/=1.21-9.13).Conclusion The AA genotype of rs7195830 is independently associated with lower estimated glomerular filtration rate and is significantly associated with CKD.

  10. Genetic Modifiers of White Blood Cell Count, Albuminuria and Glomerular Filtration Rate in Children with Sickle Cell Anemia

    Science.gov (United States)

    Flanagan, Jonathan M.; Alvarez, Ofelia A.; Nelson, Stephen C.; Aygun, Banu; Nottage, Kerri A.; George, Alex; Roberts, Carla W.; Piccone, Connie M.; Howard, Thad A.; Davis, Barry R.; Ware, Russell E.

    2016-01-01

    Discovery and validation of genetic variants that influence disease severity in children with sickle cell anemia (SCA) could lead to early identification of high-risk patients, better screening strategies, and intervention with targeted and preventive therapy. We hypothesized that newly identified genetic risk factors for the general African American population could also impact laboratory biomarkers known to contribute to the clinical disease expression of SCA, including variants influencing the white blood cell count and the development of albuminuria and abnormal glomerular filtration rate. We first investigated candidate genetic polymorphisms in well-characterized SCA pediatric cohorts from three prospective NHLBI-supported clinical trials: HUSTLE, SWiTCH, and TWiTCH. We also performed whole exome sequencing to identify novel genetic variants, using both a discovery and a validation cohort. Among candidate genes, DARC rs2814778 polymorphism regulating Duffy antigen expression had a clear influence with significantly increased WBC and neutrophil counts, but did not affect the maximum tolerated dose of hydroxyurea therapy. The APOL1 G1 polymorphism, an identified risk factor for non-diabetic renal disease, was associated with albuminuria. Whole exome sequencing discovered several novel variants that maintained significance in the validation cohorts, including ZFHX4 polymorphisms affecting both the leukocyte and neutrophil counts, as well as AGGF1, CYP4B1, CUBN, TOR2A, PKD1L2, and CD163 variants affecting the glomerular filtration rate. The identification of robust, reliable, and reproducible genetic markers for disease severity in SCA remains elusive, but new genetic variants provide avenues for further validation and investigation. PMID:27711207

  11. Wtip- and gadd45a-interacting protein dendrin is not crucial for the development or maintenance of the glomerular filtration barrier.

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    Zhijie Xiao

    Full Text Available Glomerular podocyte cells are critical for the function of the renal ultrafiltration barrier. Especially, the highly specialized cell-cell junction of podocytes, the slit diaphragm, has a central role in the filtration barrier. This is highlighted by the fact that mutations in molecular components of the slit diaphragm, including nephrin and Cd2-associated protein (Cd2ap, result in proteinuric diseases in man. Dendrin is a poorly characterized cytosolic component of the slit diaphragm in where it interacts with nephrin and Cd2ap. Dendrin is highly specific for the podocyte slit diaphragm, suggesting that it has a dedicated role in the glomerular filtration barrier. In this study, we have generated a dendrin knockout mouse line and explored the molecular interactions of dendrin. Dendrin-deficient mice were viable, fertile, and had a normal life span. Morphologically, the glomerulogenesis proceeded normally and adult dendrin-deficient mice showed normal glomerular histology. No significant proteinuria was observed. Following glomerular injury, lack of dendrin did not affect the severity of the damage or the recovery process. Yeast two-hybrid screen and co-immunoprecipitation experiments showed that dendrin binds to Wt1-interacting protein (Wtip and growth arrest and DNA-damage-inducible 45 alpha (Gadd45a. Wtip and Gadd45a mediate gene transcription in the nucleus, suggesting that dendrin may have similar functions in podocytes. In line with this, we observed the relocation of dendrin to nucleus in adriamycin nephropathy model. Our results indicate that dendrin is dispensable for the function of the normal glomerular filtration barrier and that dendrin interacts with Wtip and Gadd45a.

  12. The clearance concept with special reference to determination of glomerular filtration rate in patients with fluid retention.

    Science.gov (United States)

    Henriksen, Ulrik L; Henriksen, Jens H

    2015-01-01

    In subjects without fluid retention, the total plasma clearance of a renal filtration indicator (inulin, (99m) Tc-DTPA, (51) Cr-EDTA) is close to the urinary plasma clearance. Conversely, in patients with fluid retention (oedema, pleural effusions, ascites), there is a substantial discrepancy between the total plasma clearance and the urinary plasma clearance. This is owing to delayed indicator distribution to smaller or larger parts of the interstitial space, which in patients with ascites may simulate a peritoneal dialysator. In patients with fluid retention, urinary plasma clearance should be assessed to obtain a correct measurement of the glomerular filtration rate (GFR). In theory, total plasma clearance with late samples (24-h, 48-h) may be applied in patients with fluid retention, but validation hereof has not been performed. Until such studies are completed, it is recommended that patients with fluid retention have their GFR measured by a urinary plasma clearance technique with controlled quantitative urinary sampling within a few hours after indicator injection.

  13. Estimated glomerular filtration rate in sickle cell anemia is associated with polymorphisms of bone morphogenetic protein receptor 1B.

    Science.gov (United States)

    Nolan, Vikki G; Ma, Qianli; Cohen, Herbert T; Adewoye, Adeboye; Rybicki, Anne C; Baldwin, Clinton; Mahabir, Rhea N; Homan, Erica P; Wyszynski, Diego F; Fabry, Mary E; Nagel, Ronald L; Farrer, Lindsay A; Steinberg, Martin H

    2007-03-01

    Renal disease is common in sickle cell anemia. In this exploratory work, we used data from a longitudinal study of the natural history of sickle cell disease to examine the hypothesis that polymorphisms (SNPs) in selected candidate genes are associated with glomerular filtration rate (GFR). DNA samples and clinical and laboratory data were available for 1,140 patients with sickle cell anemia. GFR was estimated using the Cockcroft-Gault and Schwartz formulas for adults and children, respectively. We examined approximately 175 haplotype tagging (ht) SNPs in about 70 genes of the TGFbeta/BMP pathway for their association with GFR using linear regression. Four SNPs in BMPR1B, a bone morphogenetic protein (BMP) receptor gene, yielded statistically significant associations (P values ranging from 0.015 to 0.046). Three haplotypes in this gene were also associated with GFR. The TGF-beta/BMP pathway has been associated with the development of diabetic nephropathy, which has some features in common with sickle cell nephropathy. Our results suggest that, as with other subphenotypes of sickle cell disease, renal function may be genetically modulated.

  14. Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Yu-Wei Chen; Han-Hsiang Chen; Tsang-En Wang; Ching-Wei Chang; Chen-Wang Chang; Chih-Jen Wu

    2011-01-01

    AIM: To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations. RESULTS: When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.

  15. Additive effect of polymorphisms in the β2 -adrenoceptor and NADPH oxidase p22 phox genes contributes to the loss of estimated glomerular filtration rate in Chinese.

    Science.gov (United States)

    Wang, Tao; Zhang, Yan; Ma, JingTao; Feng, Zhen; Niu, Kai; Liu, Bing

    2014-09-01

    Because increased oxidative stress may mediate the detrimental actions of enhanced sympathetic nervous activity on renal function and vice versa, we investigated the effect of the polymorphic Arg16Gly in the β2 -adrenoceptor (ADRB2) gene, Trp64Arg in the β3 -adrenoceptor (ADRB3) gene and C242T in the NADPH oxidase p22phox (CYBA) gene on estimated glomerular filtration rate (eGFR) in a Chinese population. Initially recruited from different outpatient services of HeBei General Hospital in northern China, 668 individuals were finally included in the study, with complete demographic information. Laboratory tests were performed and estimated glomerular filtration rate (eGFR) was derived from the Modification of Diet in Renal Disease (MDRD) equation for the Chinese population. Plasma noradrenaline levels and genotype were determined by HPLC and the TaqMan method, respectively. Only across the Arg16Gly polymorphism did eGFR show significant difference: it was lower in individuals with the Gly16Gly variation, who also had the highest plasma noradrenaline levels. This polymorphism remained a significant determinant of eGFR after multivariate analysis. Of importance, the multifactor dimensionality reduction method further detected a significant synergism between the Arg16Gly and C242T polymorphisms in reducing eGFR. These observations clarify the effects of the studied polymorphisms on eGFR and exemplify gene-gene interactions influencing renal function.

  16. Potential Effect of Substituting Estimated Glomerular Filtration Rate for Estimated Creatinine Clearance for Dosing of Direct Oral Anticoagulants.

    Science.gov (United States)

    Schwartz, Janice B

    2016-10-01

    To determine the potential effect of substituting glomerular filtration rate (GFR) estimates for renal clearance estimated using the Cockcroft-Gault method (CrCL-CG) to calculate direct oral anticoagulant (DOAC) dosing. Simulation and retrospective data analysis. Community, academic institution, nursing home. Noninstitutionalized individuals aged 19 to 80 from the National Health and Nutrition Examination Survey (NHANES) (2011/12) (n = 4,687) and medically stable research participants aged 25 to 105 (n = 208). Age, height, weight, sex, race, serum creatinine, CrCL-CG, and GFR (according to the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations). Outcome measures were dosing errors if GFR were to be substituted for CrCL-CG. Renal clearance estimates according to all methods were highly correlated (P < .001), although at lower clearances, substitution of GFR estimates for CrCL-CG resulted in failure to recognize needs for dose reductions of rivaroxaban or edoxaban in 28% of NHANES subjects and 47% to 56% of research subjects. At a CrCL-CG of less than 30 mL/min, GFR estimates missed indicated dosage reductions for dabigatran in 18% to 21% of NHANES subjects and 57% to 86% of research subjects. Age and weight contributed to differences between renal clearance estimates (P < .001), but correction of GFR for body surface area (BSA) did not reduce dosing errors. At a CrCL-CG greater than 95 mL/min, edoxaban is not recommended, and GFR esimates misclassified 24% of NHANES and 39% of research subjects. Correction for BSA reduced misclassification to 7% for NHANES and 14% in research subjects. Substitution of GFR estimates for estimated CrCl can lead to failure to recognize indications for reducing DOAC dose and potentially higher bleeding rates than in randomized trials. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  17. Comparison of glomerular filtration rate measured between anterior and posterior image processing using Gates’ method in an ectopic pelvic kidney

    Science.gov (United States)

    Li, Na; Li, Baojun; Liang, Wenli

    2016-01-01

    Objective The aim of this study was to evaluate the difference in measured glomerular filtration rate (GFR) of an ectopic pelvic kidney between anterior and posterior image processing using Gates’ method of renal dynamic imaging. Methods A total of 10 patients were studied retrospectively, with a single ectopic kidney in the pelvic cavity and a contralateral kidney at its normal anatomical position confirmed by ultrasound, computed tomography, renal dynamic imaging, etc. All images of ectopic kidneys were processed, and GFRs were measured using anterior and posterior Gates’ method of renal dynamic imaging, respectively. The contralateral normal kidney was only processed on posterior imaging. The total GFRant of one patient, which was equal to the sum of the GFR of a normal kidney on posterior imaging and the GFR of an ectopic kidney on anterior imaging, was compared with the total GFRpost of two kidneys on posterior imaging, with the GFRtwo-sample from the two-sample method, and with the estimated GFR in the Chronic Kidney Disease Epidemiology Collaboration equation. All correlation analyses were carried out between GFRs obtained from three methods, and all patients were followed up. For statistical analysis, nonparametric rank tests were used, Bland-Altman graphs were plotted. Results The mean GFR of the ectopic kidney on anterior imaging was 27.48±12.24 ml/min/1.73 m2. It was higher than the GFR (10.71±4.74 ml/min/1.73 m2) on posterior imaging (t=−2.803, P0.05), but there were statistical differences in the accuracy within 10% of the total GFRant and that of the total GFRpost (Pectopic pelvic kidney in renal dynamic imaging. PMID:26867167

  18. Serum resistin and glomerular filtration rate in patients with type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Lorena Ortega Moreno

    Full Text Available High serum levels of the pro-inflammatory adipokine resistin have been associated with decreased renal function in the general population. The goal of this study was to investigate whether such association is also present among diabetic subjects, who are at increased risk of renal function loss.The cross-sectional association between serum resistin levels and estimated glomerular filtration rate (eGFR was investigated in 1,560 type 2 diabetic (T2D patients of European ancestry comprised in two different cohorts: 762 patients from San Giovanni Rotondo (SGR; Italy and 798 patients from Boston (US.Serum resistin was inversely associated with eGFR in SGR [β (SE for one SD of resistin increment = -1.01 (0.70 ml/min/1.73 m(2, p = 0.019] and in Boston [β (SE = -5.31 (0.74 ml/min/1.73 m(2, p < 0.001] samples, as well as in the two studies combined [β (SE = -3.42 (0.52 ml/min/1.73 m(2, p < 0.001]. The association was unaffected by adjustment for smoking habits, BMI, waist circumference, diabetes duration, HbA1c, insulin treatment, hypertension and lipid-lowering therapy: β (SE for one SD of resistin increment = -1.07 (0.70, p = 0.02; -5.50 (0.88, p < 0.001; and -2.81 (0.55 ml/min/1.73 m(2, p < .001, in SGR, Boston and the two studies combined, respectively. The association was significantly stronger in men than in women (p for resistin-by-gender interaction = 0.003. For each resistin SD increment, the odds of having eGFR < 0 ml/min/1.7 3m(2 increased by 22% (OR = 1.22; 95% CI 1.02-1.44; p = 0.025 in SGR sample, 69% (OR = 1.69; 95% CI 1.38-2.07; p < 0.001 in Boston sample, and 47% (OR = 1.47; 95% CI 1.29-1.68; p < 0.001 in the two studies considered together. Similar associations were observed in the adjusted model: OR 95% CI for each SD resistin increment being 1.23 (1.03-1.46, p = 0.021; 1.52 (1.20-1.92, p < 0.001; 1.33 (1.16-1.53, p < 0.001, in SGR, Boston and the two studies combined, respectively.This is the first report of an association between

  19. Comparison of glomerular filtration rates by dynamic renal scintigraphy and dual-plasma sample clearance method in diabetic nephropathy%肾动态显像法与双血浆法测定糖尿病肾病患者GFR的比较

    Institute of Scientific and Technical Information of China (English)

    解朋; 黄建敏; 潘莉萍; 刘晓梅; 魏玲格; 高建青

    2010-01-01

    目的 以双血浆法测得的肾小球滤过率(GFR)为参考标准,评价99Tcm-DTPA肾动态显像法测得的糖尿病肾病患者GFR的可靠性及准确性.方法 选择46例确诊为糖尿病肾病的患者,分别采用肾动态显像法和双血浆法测定其GFR(GFR肾动态法和GFR双血浆法).用配对t检验分析经体表面积标准化(1.73 m-2)的GFR肾动态法与GFR双血浆法间的差异有无统计学意义,并行相关性分析.结果 46例糖尿病肾病患者的GFR肾动态法范围为11.87~107.00 ml·min-1,均值为(51.08±26.78)ml·min-1;GFR双血浆法范围为4.17~118.56ml·min-1,均值为(44.06±29.43)ml·sin-1;两者间差异有统计学意义(t=4.209,P=0.000),前者略高于后者,且两者呈显著正相关(r=0.923,P=0.000),直线回归方程为GFR双血浆法=1.015×GFR肾动态法-7.773(F=254.656,P=0.000).结论 GFR肾动志法与GFR双血浆法的差异有统计学意义,对于糖尿病肾病患者尚不能用GFR肾动态法代替GFR双血浆法;但肾动态显像法能够较准确评价糖尿病肾病患者的肾滤过功能.%Objective To evaluate the accuracy of renal scintigraphy for the estimation of glomerular filtration rates (dGFR) in patients with diabetic nephropathy as compared to the conventional dual-plasma sample clearance method (pscGFR). Methods Forty-six patients with diabetic nephropathy underwent both dynamic renal scintigraphy and dual-plasma sample measurement after 99Tcm-DTPA injection. Paired student t-test and correlation analysis were performed to compare dGFR and pscGFR (normalized to body surface area,1.73 m-2). Results The mean dGFR was higher than mean pscGFR ((51.08±26.78)ml·min-1vs (44.06±29.43)ml·min-1,t=4.209,P=0.000). The dGFR correlated with pscGFR ( r=0.923,P=0.000) linearly (regression equation:pscGFR=1.015×dGFR-7.773,F=254. 656,P=0.000).Conclusions dGFR correlated well with pscGFR. Although it could not absolutely replace the latter in patients with diabetic nephropathy,dGFR could

  20. Prognostic abilities of different calculation formulas for the glomerular filtration rate in elderly Chinese patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fu S

    2013-02-01

    Full Text Available Shihui Fu, Yuan Liu, Bing Zhu, Tiehui Xiao, Shuangyan Yi, Yongyi Bai, Ping Ye, Leiming LuoDepartment of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of ChinaObjective: As a standard indicator of renal function, the glomerular filtration rate (GFR is vital for the prognostic analysis of elderly patients with coronary artery disease (CAD. Thus, the search for the calculation equation of GFR with the best prognostic ability is an important task. The most commonly used Modification of Diet in Renal Disease (MDRD equation and the Chinese version (CMDRD of the MDRD equation has many shortcomings. The newly developed Mayo Clinic quadratic (Mayo and Chronic Kidney Disease (CKD Epidemiology Collaboration (CKD-EPI equations may overcome these shortcomings. Because the populations involved in these equation-related studies are almost completely devoid of subjects > 70 years of age, there are more debates on the performance of these equations in the elderly. This study was designed to compare the prognostic abilities of different calculation formulas for the GFR in elderly Chinese patients with CAD.Methods: This study included 1050 patients (≥60 years of age with CAD. The endpoint was all-cause mortality over a mean follow-up period of 417 days.Results: The median age was 86 years (60–104 years. The median values for the MDRD-GFR, CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 66.0, 69.2, 65.6, and 75.8 mL/minute/1.73 m2, respectively. The prevalence of GFR < 60 mL/minute/1.73 m2 based on these measures was 39.3%, 35.4%, 43.0%, and 28.7%, respectively. Their area under the curve values for predicting death were 0.611, 0.610, 0.625, and 0.632, respectively. Their cut-off points for predicting death were 54.1, 53.5, 48.0, and 57.4 mL/minute/1.73 m2, respectively. Compared with the MDRD-GFR, the net reclassification improvement values of the CMDRD-GFR, CKD-EPI-GFR, and Mayo-GFR were 0.02, 0.10, and 0.14, respectively

  1. Progresión de la Poliquistosis renal autosómica dominante: Influencia de polimorfismos de genes de sintasa endotelial del óxido nítrico (ecNOS y del sistema renina-angiotensina Glomerular filtration rate decline in autosomic dominant polycystic kidney disease. Influence of endothelial NO synthase (ecNOS and renin angiotensin system gene polymorphisms

    Directory of Open Access Journals (Sweden)

    Pablo Azurmendi

    2004-04-01

    Full Text Available La velocidad de progresión (VdP de la poliquistosis renal autosómica dominante (PQRAD es variable. Estudiamos la asociación de los polimorfismos AGTM235T (angiotensinógeno, AT1A1166C (ATR1 y ecNOSGlu298Asp (NO sintasa endotelial con la VdP en 88 pacientes. VdP fue estimada por 1/Cr pl vs edad. Consideramos edades de Cr pl 2 y 6 mg/dl como comienzo de progresión (E2 y arribo a insuficiencia renal crónica terminal (E6, respectivamente. Los polimorfismos se estudiaron por PCR-RFLP. El grupo en su totalidad presentó VdP (ml/min/año de 6.9±0.5, E2 y E6 de 48.9±1.3 y 55.0±1.4 años y tensión arterial media (TAM de 111.2±1.2 mmHg. Según E6 observamos dos grupos (£ y > a 55 años. En £ 55 (fenotipo PKD1, n=42, E2 y E6 del genotipo CC de AT1A1166C fueron 36.0±1.2 y 41.4±0.9 años vs. AA-AC (42.8±1.0 y 47.5±0.8, p Glomerular filtration rate decline (GFRd is variable in autosomic dominant polycystic kidney disease (ADPKD. In 88 ADPKD patients, GFRd was assessed by 1/S Cr and compared with the association to AT1A1166C (AT1R, AGTM235T (angiotensinogen and ecNOSGlu298Asp (NO endothelial synthase polymorphisms. Age at S Cr values of 2 and 6 mg/dl were assumed as beginning of progressive phase (A2 and end-stage-renal disease (A6, respectively. Polymorphisms were studied by PCR-RFLP. The group as a whole showed GFRd (ml/min/year of 6.9±0.5; A2 and A6 of 48.9±1.3 and 55.0±1.4 years and mean arterial pressure of 111.2±1.2 mmHg. When A6 was considered, two populations were defined (£ and > 55 years. In £ 55 (assumed as PKD1 phenotype (n=42, A2 and A6 of the AT11166CC genotype were 36.0±1.2 and 41.4±0.9 years vs AA-AC (42.8±1.0 and 47.5±0.8, p<0.001. A2 and A6 of the ecNOS298Asp/Asp genotype were 34.8±1.5 and 41.1±0.6 years vs. Glu/Glu-Glu/Asp (42.4±0.9 and 47.1±0.8, p<0.02. In AGT235TT genotype, GFRd was 12.4±2.2 ml/min/year vs MM-MT (7.9±0.7, p<0.03. This difference was also observed when all ADPKD patients were considered (TT

  2. Resolution of the three dimensional structure of components of the glomerular filtration barrier.

    Science.gov (United States)

    Arkill, Kenton P; Qvortrup, Klaus; Starborg, Tobias; Mantell, Judith M; Knupp, Carlo; Michel, C Charles; Harper, Steve J; Salmon, Andy H J; Squire, John M; Bates, Dave O; Neal, Chris R

    2014-02-01

    The human glomerulus is the primary filtration unit of the kidney, and contains the Glomerular Filtration Barrier (GFB). The GFB had been thought to comprise 3 layers - the endothelium, the basement membrane and the podocyte foot processes. However, recent studies have suggested that at least two additional layers contribute to the function of the GFB, the endothelial glycocalyx on the vascular side, and the sub-podocyte space on the urinary side. To investigate the structure of these additional layers is difficult as it requires three-dimensional reconstruction of delicate sub-microscopic (<1 μm) cellular and extracellular elements. Here we have combined three different advanced electron microscopic techniques that cover multiple orders of magnitude of volume sampled, with a novel staining methodology (Lanthanum Dysprosium Glycosaminoglycan adhesion, or LaDy GAGa), to determine the structural basis of these two additional layers. Serial Block Face Scanning Electron Microscopy (SBF-SEM) was used to generate a 3-D image stack with a volume of a 5.3 x 105 μm3 volume of a whole kidney glomerulus (13% of glomerular volume). Secondly, Focused Ion Beam milling Scanning Electron Microscopy (FIB-SEM) was used to image a filtration region (48 μm3 volume). Lastly Transmission Electron Tomography (Tom-TEM) was performed on a 0.3 μm3 volume to identify the fine structure of the glycocalyx. Tom-TEM clearly showed 20 nm fibre spacing in the glycocalyx, within a limited field of view. FIB-SEM demonstrated, in a far greater field of view, how the glycocalyx structure related to fenestrations and the filtration slits, though without the resolution of TomTEM. SBF-SEM was able to determine the extent of the sub-podocyte space and glycocalyx coverage, without additional heavy metal staining. Neither SBF- nor FIB-SEM suffered the anisotropic shrinkage under the electron beam that is seen with Tom-TEM. These images demonstrate that the three dimensional structure of the GFB can

  3. A re-evaluation of the determinants of glomerular filtration rate

    DEFF Research Database (Denmark)

    Karlsen, F M; Holstein-Rathlou, N H; Leyssac, P P

    1995-01-01

    mechanism, while larger changes in the APR cause near parallel changes in the GFR mainly because of the effect on tubular pressure. The hydraulic resistance in the distal nephron segments is an additional factor in regulating GFR, through its effect on proximal tubular pressure. The stimulus to the TGF...... advocated here, TGF-mediated changes in afferent arteriolar resistance and angiotensin-mediated changes in efferent arteriolar resistance and APR cooperate in counteracting perturbations in proximal tubular pressure and Henle loop flow. However, because of the biphasic proximal effect of angiotensin II......Several factors are potentially able to change the glomerular filtration rate (GFR) and thereby participate in its regulation, but only a few factors seem to be physiologically important. The variable nature of proximal tubular pressure should be recognized as important in the regulation of GFR...

  4. On determinants of glomerular filtration rate after inhibition of proximal tubular reabsorption

    DEFF Research Database (Denmark)

    Leyssac, P P; Karlsen, F M; Holstein-Rathlou, N H

    1994-01-01

    The carbonic anhydrase inhibitor acetazolamide (ACZ) inhibits the absolute rate of proximal reabsorption (APR), causes a reduction in glomerular filtration rate (GFR), and activates the tubuloglomerular feedback mechanism (TGF) resulting in afferent vasoconstriction. The quantitative importance...... vasoconstriction seen after carbonic anhydrase inhibition fails to restore GFR to its control value. This is due to the high flow resistance in the distal nephron segments during the increased tubular flow rates seen after ACZ. The high distal flow resistance causes a parallel change in Pgc and Pprox and thus...... leaves delta P nearly unchanged. The present study highlights the importance of the distal flow resistance in determining delta P and therefore GFR during conditions where tubular flow rate is increased....

  5. Association of Hepatitis C Virus Infection with Proteinuria and Glomerular Filtration Rate.

    Science.gov (United States)

    Kurbanova, Nargiza; Qayyum, Rehan

    2015-10-01

    Despite several studies, the extent to which hepatitis C virus (HCV) infection is associated with chronic kidney disease (CKD) remains controversial. Thus, we examined the relationship between HCV and CKD using the continuous National Health and Nutrition Examination Survey (1999-2012). Specimens positive for anti-HCV antibodies were retested and confirmed with recombinant immunoblot assay (RIBA). Proteinuria was defined as urine albumin creatinine ratio > 30 mg/g. CKD was defined as estimated glomerular filtration rate (GFR) proteinuria (OR = 1.40, p = 0.01 and OR = 1.50, p = 0.02, respectively). In both unadjusted and adjusted analyses, individuals with HCV had significantly higher GFR than individuals without (1.4 mL/min, p = 0.04 and 2.7 mL/min, p proteinuria and high GFR but not with CKD. The biological mechanism of the observed association needs further study. © 2015 Wiley Periodicals, Inc.

  6. Estimation of glomerular filtration rate from plasma creatinine concentration in children.

    Science.gov (United States)

    Counahan, R; Chantler, C; Ghazali, S; Kirkwood, B; Rose, F; Barratt, T M

    1976-11-01

    The relation between the true plasma creatinine concentration (Pc) and the glomerular filtration rate corrected for body surface area (GFR/SA) was investigated in 108 individuals, and the following formula was derived: GFR/SA (ml/min per 1-73m2SA) = 0-43 Ht (cm)/Pc (mg/100 ml). This formula was tested in a second group of 83 children, and its accuracy and precision was compared to the 24-hour creatinine clearance. It was found to be superior to the creatinine clearance overall, and was as good, even if all results involving suspect 24-hour-urine collections were eliminated from analysis. The formula in SI usage is: GFR/SA (ml/min per 1-73 m2SA) = 38 Ht (cm)1Pc (mumol/l).

  7. Serum Adiponectin and Glomerular Filtration Rate in Patients with Type 2 Diabetes.

    Directory of Open Access Journals (Sweden)

    Lorena Ortega Moreno

    Full Text Available High serum adiponectin has been increased in several conditions of kidney disease. Only sparse and conflicting results have been reported in patients with type 2 diabetes (T2D, a subgroup of individuals who are at high risk for renal dysfunction. The aim of this study was to fill up this gap of knowledge by investigating such association in a large sample of Italian diabetic patients. The association between serum adiponectin levels and estimated glomerular filtration rate (eGFR by Chronic Kidney Disease-Epidemiology Collaboration CKD-EPI equation was investigated in 1,243 patients with T2D from two cross-sectional Italian studies: 878 from San Giovanni Rotondo (SGR and 365 from Foggia (FG. Serum adiponectin was inversely associated with eGFR in SGR [β (standard error, SE for 1 standard deviation (SD of adiponectin = -3.26 (0.64] and in FG [β(SE=-5.70(1.28] sample, as well as in the two studies combined [β(SE=-3.99(0.59];(p<0.0001 for all. In this combined analysis, the association was still significant after adjusting for sex, smoking habits, body mass index (BMI, waist circumference, diabetes duration, glycated hemoglobin (HbA1c, albumin creatinine ratio (ACR and anti-hyperglycemic, anti-hypertensive and anti-dyslipidemic treatments [β (SE= -2.19 (0.59, p = 0.0001]. A stronger association between each SD adiponectin increment and low eGFR was observed among patients with micro-/macro-albuminuria, as compared to those with normo-albuminuria [adjusted β(SE=-4.42(1.16 ml/min/1.73m2 vs. -1.50 (0.67 ml/min/1.73m2, respectively; p for adiponectin-by-albuminuric status = 0.022]. For each adiponectin SD increment, the odds of having eGFR < 60 ml/min/1.73m2 increased by 41% (odds ratio, OR = 1.41; 95% confidence interval, CI 1.21-1.64 in SGR sample, 53% (OR = 1.53; 95% CI 1.21-1.94 in FG sample, and 44% (OR = 1.44; 95%CI 1.27-1.64 in the two studies considered together (p<0.0001 for all. In the combined sample, further adjustment for the above

  8. Glomerular filtration rate, cardiovascular risk factors and insulin resistance Filtrado glomerular, riesgo cardiovascular y resistencia a la insulina

    Directory of Open Access Journals (Sweden)

    Martín R. Salazar

    2009-10-01

    Full Text Available The aim of this paper was to study the estimated glomerular filtration rate (eGFR, its changes with age, and its association with systolic blood pressure (SBP and diastolic BP (DBP, indicators of obesity, dyslipemia, insulin resistance and inflammation on a random population sample. BP, weight, size and waist circumference (WC were recorded at home. Fasting morning blood samples were analysed. The eGFR was calculated with MDRD (eGFR-MDRD, Cockroft-Gault (eGFR-CG adjusted to 1.73 m² and reciprocal of serum creatinine (100/serum cretinine. A total of 1016 individuals, 722 females (41.97 ± 0.66 years old and 294 males (42.06 ± 0.99 years old, completed the laboratory tests. The mean of 100/Scr was 115.13 ± 0.60 (dl/mg, the mean eGFR-CG was 98.48 ± 0.82 ml/min/1.73 m²; the mean eGFR-MDRD was 85.15 ± 0.58 ml/min/1.73 m². The eGFR-MDRD decreased with age and with the number of risk factors in both sexes. The eGFR-MDRD El objetivo fue evaluar en una muestra poblacional aleatoria el filtrado glomerular estimado (FGe, sus cambios con la edad y su asociación con presión arterial sistólica (PAS y diastólica (PAD, indicadores de obesidad, dislipemia, resistencia a la insulina e inflamación. En cada domicilio fueron medidos presión arterial, peso y talla y perímetro de la cintura (PC. Se analizaron muestras de sangre en ayunas y fue calculado el FGe usando las fórmulas de MDRD (FGe-MDRD y Cockroft-Gault (FGe-CG ajustado a 1.73 m², y la inversa de la creatinina sérica (100/CrS. Completaron el protocolo de laboratorio 1016 sujetos, 722 mujeres (41.97 ± 0.66 años y 294 varones (42.06 ± 0.99 años. La media de 100/Crs fue 115.13 ± 0.60 (dl/mg, la del FGe-CG 98.48 ± 0.82 ml/min/1.73 m² y la del FGe-MDRD 85.15 ± 0.58 ml/min/1.73 m² (CI 95% 84.00-86.29. El FGe-MDRD disminuyó con la edad y con el número de factores de riesgo cardiovascular en ambos sexos. La prevalecencia ajustada de FGe-MDRD < 60 ml/min/1.73 m² fue 6.2 por 100

  9. Correlation between post-transplant glomerular filtration rate in 1 year and long-term graft survival in renal transplant patients%肾移植术后一年时的肾小球滤过率与移植肾长期功能的相关性研究

    Institute of Scientific and Technical Information of China (English)

    任雨; 姚许平; 姜继光; 祁洪刚; 张曙伟; 高文波; 楼江涌; 翁锡君; 翁国斌

    2010-01-01

    目的 探讨肾移植受者术后1年时的肾小球滤过率(GFR)与移植肾长期功能的相关性. 方法 回顾性分析1994年11月至2004年10月间334例肾移植受者的临床资料.根据术后1年时的GFR不同,将受者分成肾功能正常组(≥1.083 ml/s; 267例)和肾功能异常组(GFR<1.083 ml/s;67例))GFR采用Coekeroft-Gault(C-G)公式进行计算.采用Kaplan-Meier方法比较两组受者术后5年时移植肾的长期存活率;分析术后1年与术后5年时GFR的相关性. 结果 肾移植术后移植肾存活率呈现逐年下降趋势,术后1年时的GFR与移植肾存活时间成正比,术后同一时间点(5年、10年),肾功能正常组(不包括或包括肾功能正常的死亡者)移植.肾的长期存活率均高于肾功能异常组,两组比较,差异有统计学意义(P<0.05).与术后1年时GFR比较,术后5年时的GFR变化幅度为(0.080±0.248)ml/s,其下降程度与术后1年时的GFR呈现明显正相关性. 结论 术后1年时的GFR水平影响移植肾的长期功能,术后1年时的GFR越高,术后5年的GFR也越高.%Objective To explore the correlation between post-transplant glomerular filtration rate (GFR) in 1 year and long-term graft survival in renal transplant patients.Methods The clinical data of 334 patients who received their cadaveric kidney transplantations between November 1994 and October 2004 were analyzed retrospectively.According to the GFR at one year after transplant operation, normal GFR group was defined as GFR more than or equal to 1.083 ml/s, while patients whose GFR less than 1.083 ml/s were fallen into abnormal GFR group.Cockeroft-Gault (C-G) formula was used to compare the difference in the renal function between the two groups.Kaplan-Meier assay was used to compare the difference in the allograft survival between the two groups in the functional renal allograft or the non-functional renal allograft.The correlativity of GFR level at the first year and the GFR level at the 5th year was

  10. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, K.; Coresh, J.; Sang, Y.; Chalmers, J.; Fox, C.; Guallar, E.; Jafar, T.; Jassal, S.K.; Landman, G.W.; Muntner, P.; Roderick, P.; Sairenchi, T.; Schottker, B.; Shankar, A.; Shlipak, M.; Tonelli, M.; Townend, J.; Zuilen, A. van; Yamagishi, K.; Yamashita, K.; Gansevoort, R.; Sarnak, M.; Warnock, D.G.; Woodward, M.; Arnlov, J.; Wetzels, J.F.M.

    2015-01-01

    BACKGROUND: The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a

  11. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes : a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, Kunihiro; Coresh, Josef; Sang, Yingying; Chalmers, John; Fox, Caroline; Guallar, Eliseo; Jafar, Tazeen; Jassal, Simerjot K.; Landman, Gijs W. D.; Muntner, Paul; Roderick, Paul; Sairenchi, Toshimi; Schoettker, Ben; Shankar, Anoop; Shlipak, Michael; Tonelli, Marcello; Townend, Jonathan; van Zuilen, Arjan; Yamagishi, Kazumasa; Yamashita, Kentaro; Gansevoort, Ron; Sarnak, Mark; Warnock, David G.; Woodward, Mark; Arnlov, Johan; de Zeeuw, Dick

    Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a

  12. Preliminary Findings of Serum Creatinine and Estimated Glomerular Filtration Rate (eGFR) in Adolescents with Intellectual Disabilities

    Science.gov (United States)

    Lin, Jin-Ding; Lin, Lan-Ping; Hsieh, Molly; Lin, Pei-Ying

    2010-01-01

    The present study aimed to describe the kidney function profile--serum creatinine and estimated glomerular filtration rate (eGFR), and to examine the relationships of predisposing factors to abnormal serum creatinine in people with intellectual disabilities (ID). Data were collected by a cross-sectional study of 827 aged 15-18 years adolescents…

  13. Outcome Assessment of a Computer-Animated Model for Learning about the Regulation of Glomerular Filtration Rate

    Science.gov (United States)

    Gookin, Jody L.; McWhorter, Dan; Vaden, Shelly; Posner, Lysa

    2010-01-01

    The regulation of the glomerular filtration rate (GFR) is a particularly important and challenging concept for students to integrate into a memorable framework for building further knowledge and solving clinical problems. In this study, 76 first-year veterinary students and 19 veterinarians in clinical specialty training (house officers)…

  14. One-sample determination of glomerular filtration rate (GFR) in children. An evaluation based on 75 consecutive patients

    DEFF Research Database (Denmark)

    Henriksen, Ulrik Lütken; Kanstrup, Inge-Lis; Henriksen, Jens Henrik Sahl

    2013-01-01

    Abstract Background and aim. From a clinical point of view determination of glomerular filtration rate (clearance) is important. The aim of the present study was to compare the one-sample clearance to reference multiple-sample (51)Cr-EDTA clearance in consecutively referred children suspected of ...

  15. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes : a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, Kunihiro; Coresh, Josef; Sang, Yingying; Chalmers, John; Fox, Caroline; Guallar, Eliseo; Jafar, Tazeen; Jassal, Simerjot K.; Landman, Gijs W. D.; Muntner, Paul; Roderick, Paul; Sairenchi, Toshimi; Schoettker, Ben; Shankar, Anoop; Shlipak, Michael; Tonelli, Marcello; Townend, Jonathan; van Zuilen, Arjan; Yamagishi, Kazumasa; Yamashita, Kentaro; Gansevoort, Ron; Sarnak, Mark; Warnock, David G.; Woodward, Mark; Arnlov, Johan; de Zeeuw, Dick

    2015-01-01

    Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-

  16. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, K.; Coresh, J.; Sang, Y.; Chalmers, J.; Fox, C.; Guallar, E.; Jafar, T.; Jassal, S.K.; Landman, G.W.; Muntner, P.; Roderick, P.; Sairenchi, T.; Schottker, B.; Shankar, A.; Shlipak, M.; Tonelli, M.; Townend, J.; Zuilen, A. van; Yamagishi, K.; Yamashita, K.; Gansevoort, R.; Sarnak, M.; Warnock, D.G.; Woodward, M.; Arnlov, J.; Wetzels, J.F.M.

    2015-01-01

    BACKGROUND: The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta

  17. C-Terminal to Intact Fibroblast Growth Factor 23 Ratio in Relation to Estimated Glomerular Filtration Rate in Elderly Population

    Directory of Open Access Journals (Sweden)

    Maria Bożentowicz-Wikarek

    2016-08-01

    Full Text Available Background/Aims: An analytical equivalence between intact fibroblasts growth factor(iFGF23 and C-terminal(cFGF23 assays is logically expected, however, numerous studies demonstrate lack of a strong association between them. Previously, we have demonstrated the increase in cFGF23 slightly precedes the increase of iFGF23 with the impairment of kidney excretory function; without actually analyzing the ratio between both assays, which are postulated to be affected by declining kidney function. Therefore, the aim of this study was to analyze the ratio between C and iFGF23 in relation to the estimated glomerular filtration rate (eGFR in an elderly population. Methods: We analysed the variability of c/iFGF23 ratio in the population of 3264 elderly PolSenior study participants (≥ 65years in the relation to eGFR calculated according full Modification of Diet in Renal Disease, serum levels of C-reactive protein (hs-CRP, and iron. Results: The log10(c/i FGF23 ratio increased in the subsequent CKD stages. Serum iron and CRP levels reduced the log10 and increased it with age in multivariate regression analysis. Conclusions: Our results suggest impairment in the cleavage of the C-terminal FGF23 fragments with the deterioration of kidney excretory function and age in the elderly population. Inflammation and low serum iron level seems to diminish degradation capacity of FGF23 fragments.

  18. 24-hour creatinine clearance reliability for estimation of glomerular filtration rate in different stages of chronic kidney disease

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    El-Minshawy Osama

    2010-01-01

    Full Text Available Glomerular Filtration Rate (GFR is considered the best overall index of renal function currently used. Measurement of 24 hours urine/plasma creatinine ratio (UV/P is usually used for estimation of GFR. However little is known about its accuracy in different stages of Chronic Kidney Disease (CKD aim: is to evaluate performance of UV/P in classification of CKD by comparing it with isotopic GFR (iGFR. 136 patients with CKD were enrolled in this study 80 (59% were males, 48 (35% were diabetics. Mean age 46 ± 13. Creatinine Clearance (Cr.Cl estimated by UV/P and Cockroft-Gault (CG was done for all patients, iGFR was the reference value. Accuracy of UV/P was 10%, 31%, 49% within ± 10%, ± 30%, ± 50% error respectively, r 2 = 0.44. CG gave a better performance even when we restrict our analysis to diabetics only, the accuracy of CG was 19%, 47%, 72% in ± 10%, ± 30% and ± 50% errors respectively, r 2 = 0.63. Both equations gave poor classification of CKD. In conclusion, UV/P has poor accuracy in estimation of GFR, The accuracy worsened as kidney disease becomes more severe. We conclude 24 hours CrCl. is not good substitute for measurement of GFR in patients with CKD.

  19. Measurement of glomerular filtration rate in adults: accuracy of five single-sample plasma clearance methods

    DEFF Research Database (Denmark)

    Rehling, M; Rabøl, A

    1989-01-01

    After an intravenous injection of a tracer that is removed from the body solely by filtration in the kidneys, the glomerular filtration rate (GFR) can be determined from its plasma clearance. The method requires a great number of blood samples but collection of urine is not needed. In the present......-acetate) was determined simultaneously. Using these clearance values as reference the accuracy of six simplified methods were studied: five single-sample methods and one five-sample method. The standard error of estimate (SEE) of the single-sample methods ranged from 4.2 to 7.5 ml min-1 using EDTA, and from 3.8 to 6.3 ml...... min-1 using DTPA. SEE of the five-samples method was 3.0 ml min-1 (EDTA) and 3.1 ml min-1 (DTPA). The single-sample methods given by Christensen & Groth (1986) and by Tauxe (1986) are recommended for daily use, as SEE was small even at low GFR values. In patients with GFR less than 80 ml min-1...

  20. 慢性肾功能衰竭患者血清瘦素水平与肾小球滤过率及炎症递质的相关性研究%The Study on the Relation between Serum Leptin Levels,Glomerular Filtration Rate (GFR),and Inflammatory Mediators in Patients with Chronic Renal Failure

    Institute of Scientific and Technical Information of China (English)

    朱承松

    2011-01-01

    目的 探讨慢性肾功能衰竭(CRF)患者高瘦素血症与肾小球滤过率(GFR)及炎症之间的相关性.方法 对120例不同程度CRF患者进行血清瘦素、GFR、C-反应蛋白(CRP)、IL-6及IL-8检测,观察CRP、IL-6及IL-8与高瘦素血症的相关性.结果 不同程度CRF患者与对照者比较,GFR、瘦素、CRP、IL-6及IL-8水平间差异均有统计学意义(P<0.05).血清瘦素水平与GFR呈负相关(r=-0.23,P<0.001),与BMI呈正相关(r=0.36,P<0.001),而GFR与BMI之间无相关性(r=4.65,P>0.05).血清瘦素与CRP、IL-6及IL-8之间均呈正相关(r分别为0.54、0.47和0.51,均P<0.001).结论 CRF患者血清瘦素水平升高与GFR下降所导致的瘦素清除减少有关,全身微炎症反应也可引起高瘦素血症.%Objective To study the relationship between hyperleptindemia, GFR and inflammatory in patients with chronic renal failure. Methods Serum leptin levels, glomerular filtration rate ( GFR ), CRP, IL - 6 and IL - 8 of 120 patients having different degrees of renal failure were measured. Then the relationship between CRP, IL- 6, IL - 8 and serum leptin levels was analyzed. Results The level of serum leptin, CRP, IL- 6 and IL - 8 varied significantly in middle damaged group and severe damaged group ( P < 0. 001 ), while the level of IL - 6 and IL - 8 in middle damaged group and severe damaged group also varied significantly with that of the control group ( P < 0. 001 ). The levels of GFR, serum leptin, CRP, IL - 6 and IL - 8 in patients with different stage of kidney failure had statistical differences ( P <0. 05 ). The level of serum leptin had a negative correlation with GFR ( r = - 0. 23 , P < 0. 001 ), and positive correlation with BMI ( r = 0. 36, P < 0. 001 ), while there was no correlation between GFR and BMI ( r =4. 65, P >0. 05 ). The level of serum leptin had a positive correlation with CRP, IL -6 and IL -8 ( r = 0. 54, 0. 47, 0. 51, P <0. 001 ). Conclusion The study shows that serum

  1. High-normal serum uric acid is associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients

    Institute of Scientific and Technical Information of China (English)

    CAI Xiao-ling; HAN Xue-yao; JI Li-nong

    2011-01-01

    Background Recently,some studies had shown that elevated serum uric acid (SUA) itself may increase the risk for development of renal disease in patients with diabetes.This study aimed to explore whether SUA was a predictor of microalbuminuria and impaired renal function in type 2 diabetes in Chinese patients.Methods This cross-sectional study included 2108 type 2 diabetic patients.Kidney function was estimated using the simplified modification of diet in renal disease (MDRD) equation to obtain estimated glomerular filtration rate.The urine samples were obtained for measuring the albumin-to-creatinine ratio (ACR).Results According to the ACR level,these patients were divided into two groups,normal ACR (NA) and non-normal ACR (non-NA).Both SUA and creatinine were significantly higher in the non-NA group than those in the NA group ((318.89+107.52) vs.(283.44±88.64) μmol/L,and (95.08±53.24) vs.(79.63±18.20) μmol/L,respectively).Logistic regression analysis showed that diabetic duration,systolic blood pressure,creatinine and SUA were the independent predictors of albuminuria.Furthermore,to identify the factors associated with renal function,these patients were divided into two groups according to the MDRD level (MDRD<90 or MDRD>90).Both SUA and creatinine were significantly higher in the lower MDRD group than those in the higher MDRD group ((301.90±96.46) vs.(264.07+84.74) μmol/L,and (89.10±31.00) vs.(66.37±11.15) μ mol/L,respectively).Logistic regression analysis showed that only age and SUA were the independent predictors of MDRD.Conclusion High-normal SUA was associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients.

  2. Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

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    Christopher J. Kirwan

    2013-01-01

    Full Text Available Introduction. RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI, but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI. Aim. This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl in critically ill patients with AKI. Methods. Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl. Results. eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD. Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

  3. Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    LI Jiang-tao; XUN Chen; CUI Chun-li; WANG Hui-fang; WU Yi-tai; YUN Ai-hong; JIANG Xiao-feng; MA Jun

    2012-01-01

    Background The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed to address the systematic underestimation of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease (CKD).Methods We enrolled 450 Chinese patients (239 women and 211 men) with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR (rGFR) for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics (ROC) analysis.Performance of the two equations in lower and higher estimated GFR (eGFR) subgroups was further investigated.Results Both eGFRs correlated well with rGFR (r=0.88,0.81,P<0.05).In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

  4. Improved measurement of the glomerular filtration rate from Tc-99m DTPA scintigraphy in patients following nephrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong-il; Ha, Seunggyun [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seongnam-si, Gyeonggi-do (Korea, Republic of); So, Young [Konkuk University School of Medicine, Department of Nuclear Medicine, Chungju (Korea, Republic of); Lee, Won Woo [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of); Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seongnam-si, Gyeonggi-do (Korea, Republic of); Byun, Seok-Soo [Seoul National University College of Medicine, Department of Urology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kim, Sang Eun [Seoul National University College of Medicine, Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Seoul National University, Institute of Radiation Medicine, Medical Research Center, Seoul (Korea, Republic of)

    2014-02-15

    We aimed to improve Tc-99m DTPA glomerular filtration rate (GFR) scintigraphy (Gates' method) in a prospective study using Cr-51 EDTA GFR test as a gold standard. Fifty-seven Tc-99m DTPA GFR scintigrams in 45 subjects (male/female = 33:12, age = 45.9 ± 17.6 years, 14 healthy volunteers and 31 nephrectomised patients) were compared using Cr-51 EDTA GFR tests. Using the %renal uptake of Tc-99m DTPA and Cr-51 EDTA GFR, a revised equation for GFR was established through linear regression analysis. The revised equation for improved GFR was GFR(mL/min) = (%renal uptake x 11.7773) - 0.7354. Gates' original GFRs (70.1 ± 20.5 mL/min/1.73 m{sup 2}) were significantly lower than Cr-51 EDTA GFRs (97.0 ± 31.9 mL/min/1.73 m{sup 2}; P < 0.0001), but the improved GFRs (98.0 ± 26.3 mL/min/1.73 m{sup 2}) were not different from (P = 0.7360) and had a significant correlation with (r = 0.73, P < 0.0001) the Cr-51 EDTA GFRs. The revised GFR equation effectively demonstrated perioperative GFR changes in kidneys that were operated on and the contralateral kidneys at 3 and 6 months post-partial nephrectomy (n = 25). GFR measurement using Tc-99m DTPA scintigraphy could be significantly improved by a revised equation derived from the comparison with Cr-51 EDTA GFR. (orig.)

  5. Dietary supplementation with fish oil modifies renal reserve filtration capacity in postoperative, cyclosporin A-treated renal transplant recipients.

    Science.gov (United States)

    Homan van der Heide, J J; Bilo, H J; Donker, A J; Wilmink, J M; Sluiter, W J; Tegzess, A M

    1990-10-01

    The effect of a daily supplementation of 6 g fish oil (30% C20:5 omega-3 = EPA and 20% C22:6 omega-3 = DHA) for 1 month on renal function variables was investigated in a placebo-controlled (6 g coconut oil), prospective, randomized, double-blind study in acute postoperative cyclosporin A (CyA)-treated renal transplant recipients. Seventeen patients ingested placebo capsules (EPA-) and 14 patients fish oil (EPA+). Renal function tests were performed using the simultaneous determination of 125I-iothalamate and 131I-hippuran clearances for glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), respectively. Renal reserve filtration capacity was assessed by dopamine infusion, amino acid infusion, and a combination of both stimuli. After 1 month there were no significant differences in rejection episodes, CyA dose, or CyA levels. In contrast to our earlier observations, serum creatinine, creatinine clearance, GFR, and ERPF did not differ between the EPA- and EPA+ groups. Filtration fraction (FF) differed significantly, being 0.21 in the EPA- group versus 0.26 in the EPA+ group. To exclude the possible influence of a rejection episode, the nonrejecting patients were analyzed separately, creating the subgroups EPA + re - and EPA - re -. These two groups were comparable in age, donor age, and GFR. The EPA + re-group had a significantly lower ERPF (164 ml/min per 1.73 m2) than the EPA-re- group (262 ml/min per 1.73 m2). FF was significantly higher in the EPA+ re-group (0.26) than in the EPA-re-group (0.21).(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Effects of salt restriction on renal growth and glomerular injury in rats with remnant kidneys.

    Science.gov (United States)

    Lax, D S; Benstein, J A; Tolbert, E; Dworkin, L D

    1992-06-01

    Male Munich-Wistar rats underwent right nephrectomy and infarction of two thirds of the left kidney. Rats were randomly assigned to ingest standard chow (REM) or a moderately salt restricted chow (LS). A third group of rats were fed the low salt diet and were injected with an androgen (LSA). Eight weeks after ablation, glomerular volume and glomerular capillary radius were markedly increased in REM. This increase was prevented by the low salt diet, however, the antihypertrophic effect of the diet was overcome by androgen. Values for glomerular volume and capillary radius were similar in LSA and REM. Morphologic studies revealed that approximately 25% of glomeruli were abnormal in REM. Much less injury was observed in salt restricted rats, however, the protective effect of the low salt diet was significantly abrogated when renal growth was stimulated in salt restricted rats by androgen. Micropuncture studies revealed that glomerular pressure was elevated in all three groups and not affected by diet or androgen. Serum cholesterol was also similar in the three groups. These findings indicate that renal and glomerular hypertrophy are correlated with the development of glomerular injury after reduction in renal mass and suggest that dietary salt restriction lessens renal damage, at least in part, by inhibiting compensatory renal growth.

  7. Determinants of glomerular filtration and plasma flow in experimental diabetic rats.

    Science.gov (United States)

    Michels, L D; Davidman, M; Keane, W F

    1981-12-01

    GFR and, to a lesser extent, RPF are elevated soon after the onset of human diabetes mellitus. The mechanisms involved in these functional changes are unknown. Since the experimental diabetic rat has renal morphological changes similar to those observed in man, we investigated whole-kidney and superficial-nephron glomerular function in this animal model early during the course of the disease. Alloxan-induced diabetes (50 mg/kg BW) is frequently characterized by severe hyperglycemia and retarded body growth. Supplemental insulin administration (6 U of NPH insulin daily) results in normal body growth, although hyperglycemia persists. As a result, we studied four groups of diabetic rats (1) after 1 month of untreated diabetes, (2) after 3 months of untreated diabetes, (3) after 3 months of untreated diabetes followed by 1 month of insulin supplementation, and (4) after 3 months of insulin-supplemented diabetes. After 1 month of untreated diabetes, GFR and SNGFR each declined by 20% compared to age-matched control rats. RPF and SNGFR were both reduced by 33% as a consequence of a 41% increase in RT. Reduced SNGPF together with a 7 mm Hg reduction in PGC caused the fall in GFR and SNGFR. KWs were not significantly different from those of control rats. The functional changes that occurred after 1 month of untreated diabetes did not significantly deteriorate after 3 months of the disease. Insulin supplementation, when instituted for 1 month after 3 months of untreated diabetes, produced no significant improvement in either whole-kidney or superficial-nephron hemodynamics even though body and kidney growth were stimulated. In contrast, insulin supplementation initiated at the onset of diabetes increased both SNGFR and SNGFR to 23% above control values. GFR and RPF each increased in proportion to the 18% increment in kidney size. RT was reduced in these rats, and the pressures that govern glomerular ultrafiltration were not altered from control values. We conclude that in

  8. Height-independent estimation of glomerular filtration rate in children: an alternative to the Schwartz equation.

    Science.gov (United States)

    Blufpand, Hester N; Westland, Rik; van Wijk, Joanna A E; Roelandse-Koop, Elianne A; Kaspers, Gertjan J L; Bökenkamp, Arend

    2013-12-01

    To compare the diagnostic performance of 2 height-independent equations used to calculate estimated glomerular filtration rate (eGFR), those of Pottel (eGFR-Pottel) and the British Columbia Children's Hospital (BCCH) (eGFR-BCCH), with the commonly used Schwartz equation (eGFR-Schwartz). We externally validated eGFR-Pottel and eGFR-BCCH in a well-characterized pediatric patient population (n = 152) and compared their diagnostic performance with that of eGFR-Schwartz using Bland-Altman analysis. All patients underwent glomerular filtration rate measurement using the gold standard single-injection inulin clearance method (GFR-inulin). Median GFR-inulin was 92.0 mL/min/1.73 m² (IQR, 76.1-107.4 mL/min/1.73 m²). Compared with GFR-inulin, the mean bias for eGFR-Schwartz was -10.1 mL/min/1.73 m(2) (95% limits of agreement [LOA], -77.5 to 57.2 mL/min/1.73 m(2)), compared with -12.3 mL/min/1.73 m² (95% LOA, -72.6 to 47.9 mL/min/1.73 m(2)) for eGFR-Pottel and -22.1 mL/min/1.73 m² (95% LOA, -105.0 to 60.8 mL/min/1.73 m(2)) for eGFR-BCCH. eGFR-Pottel showed comparable accuracy to eGFR-Schwartz, with 77% and 76% of estimates within 30% of GFR-inulin, respectively. eGFR-BCCH was less accurate than eGFR-Schwartz (66% of estimates within 30% of GFR-inulin; P Schwartz. eGFR-Pottel is a valid alternative to eGFR-Schwartz in children and could be reported by the laboratory if height data are not available. Copyright © 2013 Mosby, Inc. All rights reserved.

  9. Is Increased Echogenicity Related to a Decrease in Glomerular Filtration Rate? Objective Measurements in Pediatric Solitary Kidney Patients--A Retrospective Analysis.

    Directory of Open Access Journals (Sweden)

    Yong Seung Lee

    Full Text Available Quantitative measurements of renal echogenicity using a graphic program show close correlation with renal histology in adult patients, but this has neither been applied in pediatric patients nor correlated with glomerular filtration rate (GFR. To determine the direct relationship between echogenicity and GFR, we retrospectively analyzed 91 patients with a solitary functioning kidney under the age of 10, who underwent ultrasonography and serum cystatin C evaluation on a single day between January 2013 and December 2014. Echogenicity was quantified as previously reported. Echogenicity and kidney length were correlated with age-matched values of serum cystatin C-based GFR. Evaluation was performed at a median age of 17.1 months. GFR was low for age in eight of 54 right solitary kidney patients and four of 37 left solitary kidney patients. The right kidney-liver ratio was significantly elevated in the right decreased GFR group, while the left kidney-spleen ratio was not different in the left decreased GFR group. Age-matched longitudinal kidney length ratios were similar between the decreased and normal GFR groups for both sides. This is the first report to objectively prove the relationship between echogenicity and renal function in patients with a right solitary kidney. The right kidney-liver echogenicity ratio, measured objectively, showed feasibility in clinical practice as it showed a close relationship with decreased renal function when increased. However, absolute kidney echogenicity values, or the left kidney-spleen echogenicity ratio, were not independent markers for decreased renal function.

  10. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Kirk, Ole; Reiss, Peter

    2010-01-01

    OBJECTIVES:: Chronic kidney disease (CKD) in HIV-positive persons might be caused by both HIV and traditional or non-HIV-related factors. Our objective was to investigate long-term exposure to specific antiretroviral drugs and CKD. DESIGN:: A cohort study including 6843 HIV-positive persons...... with at least three serum creatinine measurements and corresponding body weight measurements from 2004 onwards. METHODS:: CKD was defined as either confirmed (two measurements >/=3 months apart) estimated glomerular filtration rate (eGFR) of 60 ml/min per 1.73 m or below for persons with baseline eGFR of above...... 60 ml/min per 1.73 m or confirmed 25% decline in eGFR for persons with baseline eGFR of 60 ml/min per 1.73 m or less, using the Cockcroft-Gault formula. Poisson regression was used to determine factors associated with CKD. RESULTS:: Two hundred and twenty-five (3.3%) persons progressed to CKD during...

  11. Plasma hemoglobin concentration was related to estimated glomerular filtration rate in elderly patients with ischemic Cardiomyopatny

    Institute of Scientific and Technical Information of China (English)

    Gang Li; Zhihua Wang; Canjing Zhang; Yang Wang

    2008-01-01

    Objectlves To stuaythe relationship between plasma hemoglobin concentration and estimated glomerular filtration rate (eGFR)in elderly patients with ischemic cardiomyopathy (ICM).Methods Clinical data of patients with coronary heart disease who weredischarged from The First Affiliated Hospital,Chongqing Medicai University between 2005 and 2007 were analyzed retrospectively.Echocardiography resuIts.plasma hemoglobin and creatinine concentration were abstracted from the medical records.The study included235 Chinese Han patients with age 60 years and older with angiography confwmed coronary heart disease.silent myocardial ischemia orangina pectoris,of whom 154 had ICM defined as left ventricular end-diastolic diameter(LVDd),male≥56mm,female≥51 mm(63.51±7.70 mm)measured by M-mode echocardiography.The differences in plasma hemoglobin concentration were analyzed retrospec-were no significant changes in plasma hemoglobin concentration and eGFR;however,plasma hernoglobin concentration was related toeGFR significantly positively in elderly patients with ICM due to coronary heart disease.

  12. Escaping the correction for body surface area when calculating glomerular filtration rate in children

    Energy Technology Data Exchange (ETDEWEB)

    Piepsz, Amy; Tondeur, Marianne [CHU St. Pierre, Department of Radioisotopes, Brussels (Belgium); Ham, Hamphrey [University Hospital Ghent, Department of Nuclear Medicine, Ghent (Belgium)

    2008-09-15

    {sup 51}Cr ethylene diamine tetraacetic acid ({sup 51}Cr EDTA) clearance is nowadays considered as an accurate and reproducible method for measuring glomerular filtration rate (GFR) in children. Normal values in function of age, corrected for body surface area, have been recently updated. However, much criticism has been expressed about the validity of body surface area correction. The aim of the present paper was to present the normal GFR values, not corrected for body surface area, with the associated percentile curves. For that purpose, the same patients as in the previous paper were selected, namely those with no recent urinary tract infection, having a normal left to right {sup 99m}Tc MAG3 uptake ratio and a normal kidney morphology on the early parenchymal images. A single blood sample method was used for {sup 51}Cr EDTA clearance measurement. Clearance values, not corrected for body surface area, increased progressively up to the adolescence. The percentile curves were determined and allow, for a single patient, to estimate accurately the level of non-corrected clearance and the evolution with time, whatever the age. (orig.)

  13. Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events: secondary analysis.

    LENUS (Irish Health Repository)

    Ford, Ian

    2009-01-20

    Reduced glomerular filtration rate (GFR) is associated with increased cardiovascular risk in young and middle aged individuals. Associations with cardiovascular disease and mortality in older people are less clearly established. We aimed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants randomized in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).

  14. Glomerular C3d as a novel prognostic marker for renal vasculitis.

    Science.gov (United States)

    Villacorta, Javier; Diaz-Crespo, Francisco; Acevedo, Mercedes; Guerrero, Carmen; Campos-Martin, Yolanda; García-Díaz, Eugenio; Mollejo, Manuela; Fernandez-Juarez, Gema

    2016-10-01

    Pauci-immune necrotizing crescentic glomerulonephritis is the histologic substrate of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Several studies in animal models have demonstrated the crucial role of complement activation in the pathogenesis of ANCA-associated vasculitis, but only small series have analyzed the prognostic implications of complement glomerular deposits. This study aimed to assess the clinical and prognostic implications of C3d- and C4d-positive glomerular staining in renal vasculitis. Eighty-five patients with a diagnosis of pauci-immune necrotizing crescentic glomerulonephritis were included in the study. C3d and C4d were analyzed by immunohistochemical staining using a polyclonal antibody. The primary predictors were glomerular C3d- and C4d-positive staining. The primary end point was the cumulative percentage of patients who developed end-stage renal disease. Glomerular staining for C3d and C4d was observed in 42 (49.4%) of 85 biopsies and 38 (44.7%) of 85 biopsies, respectively. C3d-positive staining was associated with the severity of renal impairment and with a lower response rate to treatment (P=.003 and P=.04, respectively). Renal survival at 2 and 5 years was 60.9% and 51.8% in C3d-positive patients compared with 87.7% and 78.9% in C3d-negative patients (P=.04). C4d-positive staining did not show any impact in renal outcome. When adjusted by renal function and other histologic parameters, C3d staining remained as an independent predictor for renal survival (hazard ratio, 2.5; 95% confidence interval, 1.1-5.7; P=.03). Therefore, this study demonstrates that C3d-positive glomerular staining is an independent risk factor for the development of end-stage renal disease in ANCA-associated renal vasculitis.

  15. Establishment and evaluation of estimated glomerular filtration rate by serum cystatin C alone and in combination with serum creatinine in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    杨渝伟

    2013-01-01

    Objective To establish equations for estimating glomerular filtration rate(GFR)based on serum Cystatin C (CysC) and creatinine(Cr) concentration in Chinese adult patients with chronic kidney disease(CKD)

  16. Insulin's acute effects on glomerular filtration rate correlate with insulin sensitivity whereas insulin's acute effects on proximal tubular sodium reabsorption correlate with salt sensitivity in normal subjects

    NARCIS (Netherlands)

    ter Maaten, JC; Bakker, SJL; Serne, EH; ter Wee, PM; Gans, ROB

    1999-01-01

    Background. Insulin induces increasing distal tubular sodium reabsorption. Opposite effects of insulin to offset insulin-induced sodium retention are supposedly increases in glomerular filtration rate (GFR) and decreases in proximal tubular sodium reabsorption. Defects in these opposing effects coul

  17. Insulin's acute effects on glomerular filtration rate correlate with insulin sensitivity whereas insulin's acute effects on proximal tubular sodium reabsorption correlate with salt sensitivity in normal subjects

    NARCIS (Netherlands)

    ter Maaten, JC; Bakker, SJL; Serne, EH; ter Wee, PM; Gans, ROB

    1999-01-01

    Background. Insulin induces increasing distal tubular sodium reabsorption. Opposite effects of insulin to offset insulin-induced sodium retention are supposedly increases in glomerular filtration rate (GFR) and decreases in proximal tubular sodium reabsorption. Defects in these opposing effects coul

  18. Intermediate volume on computed tomography imaging defines a fibrotic compartment that predicts glomerular filtration rate decline in autosomal dominant polycystic kidney disease patients.

    Science.gov (United States)

    Caroli, Anna; Antiga, Luca; Conti, Sara; Sonzogni, Aurelio; Fasolini, Giorgio; Ondei, Patrizia; Perico, Norberto; Remuzzi, Giuseppe; Remuzzi, Andrea

    2011-08-01

    Total kidney and cyst volumes have been used to quantify disease progression in autosomal dominant polycystic kidney disease (ADPKD), but a causal relationship with progression to renal failure has not been demonstrated. Advanced image processing recently allowed to quantify extracystic tissue, and to identify an additional tissue component named "intermediate," appearing hypoenhanced on contrast-enhanced computed tomography (CT). The aim of this study is to provide a histological characterization of intermediate volume, investigate its relation with renal function, and provide preliminary evidence of its role in long-term prediction of functional loss. Three ADPKD patients underwent contrast-enhanced CT scans before nephrectomy. Histological samples of intermediate volume were drawn from the excised kidneys, and stained with hematoxylin and eosin and with saturated picrosirius solution for histological analysis. Intermediate volume showed major structural changes, characterized by tubular dilation and atrophy, microcysts, inflammatory cell infiltrate, vascular sclerosis, and extended peritubular interstitial fibrosis. A significant correlation (r = -0.69, P < 0.001) between relative intermediate volume and baseline renal function was found in 21 ADPKD patients. Long-term prediction of renal functional loss was investigated in an independent cohort of 13 ADPKD patients, followed for 3 to 8 years. Intermediate volume, but not total kidney or cyst volume, significantly correlated with glomerular filtration rate decline (r = -0.79, P < 0.005). These findings suggest that intermediate volume may represent a suitable surrogate marker of ADPKD progression and a novel therapeutic target.

  19. COMPARISON OF ESTIMATED GLOMERULAR FILTRATION RATE MEAN VALUE OF HARUS 15-30-60, HADI, AND ASIAN FOMULA ACCURACY IN DIABETES MELLITUS TYPE 2

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    Sylvia Rachmayati

    2015-03-01

    Full Text Available Objective: To compare the accuracy of HARUS 15-30-60, HADI, and Asian Formulas (Chinese-equation (Ch-E, Japanese-equation (Jp-E, and Thai- equation (Th-E for estimated glomerular filtration rate (eGFR. Methods: The Kidney Dialysis Outcome Quality Initiative (KDOQI has published a guideline to measure renal function, which is based on glomerular filtration rate (GFR. This procedure is complicated and expensive, therefore an estimated GFR (eGFR has been proposed. The modification of diet in renal disease (MDRD study prediction equation is the most frequently eGFR used. This method still have a weakness in accuracy, so the chronic kidney disease epidemiology collaboration (CKD-EPI formula is developed. Since CKD-EPI is not practical for daily use, the MDRD is published for Asian population that includes Ch-E, Jp-E, and Th-E. In Indonesia, the MDRD formula has not been validated using any gold standard, therefore 2 new formulas have been developed, i.e. HARUS 15-30-60 and HADI formulas. In this study, we analyzed 102 medical records of Diabetes Mellitus Type 2 (DMT2 patients who visited Dr. Hasan Sadikin General Hospital, Bandung during the period of 2012 to 2013. We analyzed the data using HARUS 15-30-60, HADI, Asian formulas, and then compared them to CKD-EPI to see the accuracy. Statistical analysis used was paired t-test in SPSS-17 program. Results: The accuracy of the different formulas are as follows: HADI (p=0.173, HARUS 15-30-60 (p=0.060, Ch-E (p=0.001, Th-E (p=0.000, and Jp-E (p=0.000. Conclusions: HADI is the most accurate formula, followed by HARUS Formula, Ch-E, and Th-E and Jp-E, respectively.

  20. A re-evaluation of the determinants of glomerular filtration rate.

    Science.gov (United States)

    Karlsen, F M; Holstein-Rathlou, N H; Leyssac, P P

    1995-12-01

    Several factors are potentially able to change the glomerular filtration rate (GFR) and thereby participate in its regulation, but only a few factors seem to be physiologically important. The variable nature of proximal tubular pressure should be recognized as important in the regulation of GFR. It is argued that a distinction should be made between the terms 'autoregulation of GFR' and 'regulation of GFR'. The tubuloglomerular feedback mechanism (TGF) is an important factor for autoregulatory control of GFR. When perturbations result in major increases in tubular flow, the TGF saturates. Proximal tubular pressure then increases and becomes the major factor responsible for the stabilization of GFR. Changes in the proximal reabsorption rate (APR) are important for long-term variations in GFR (regulation of GFR). Small changes in the APR cause near parallel changes in the GFR mainly through the TGF mechanism, while larger changes in the APR cause near parallel changes in the GFR mainly because of the effect on tubular pressure. The hydraulic resistance in the distal nephron segments is an additional factor in regulating GFR, through its effect on proximal tubular pressure. The stimulus to the TGF mechanism also depresses renin release. The resulting local angiotensin II concentration has effects both on the arteriolar resistances and on the APR. The renin-angiotensin system and TGF are therefore considered to be integrated parts of a common control system regulating GFR. According to the hypothesis advocated here, TGF-mediated changes in afferent arteriolar resistance and angiotensin-mediated changes in efferent arteriolar resistance and APR cooperate in counteracting perturbations in proximal tubular pressure and Henle loop flow. However, because of the biphasic proximal effect of angiotensin II, a major unresolved question is whether physiological increases in endogenous local angiotensin II concentrations stimulate or inhibit proximal reabsorption.

  1. Effect of prenatal programming and postnatal rearing on glomerular filtration rate in adult rats.

    Science.gov (United States)

    Lozano, German; Elmaghrabi, Ayah; Salley, Jordan; Siddique, Khurrum; Gattineni, Jyothsna; Baum, Michel

    2015-03-01

    The present study examined whether a prenatal low-protein diet programs a decrease in glomerular filtration rate (GFR) and an increase in systolic blood pressure (BP). In addition, we examined whether altering the postnatal nutritional environment of nursing neonatal rats affected GFR and BP when rats were studied as adults. Pregnant rats were fed a normal (20%) protein diet or a low-protein diet (6%) during the last half of pregnancy until birth, when rats were fed a 20% protein diet. Mature adult rats from the prenatal low-protein group had systolic hypertension and a GFR of 0.38 ± 0.03 versus 0.57 ± 0.05 ml·min(-1)·100 g body wt(-1) in the 20% group (P < 0.01). In cross-fostering experiments, mothers continued on the same prenatal diet until weaning. Prenatal 6% protein rats cross-fostered to a 20% mother on day 1 of life had a GFR of 0.53 ± 0.05 ml·min(-1)·100 g body wt(-1), which was not different than the 20% group cross-fostered to a different 20% mother (0.45 ± 0.04 ml·min(-1)·100 g body wt(-1)). BP in the 6% to 20% group was comparable with the 20% to 20% group. Offspring of rats fed either 20% or 6% protein diets during pregnancy and cross-fostered to a 6% mother had elevated BP but a comparable GFR normalized to body weight as the 20% to 20% control group. Thus, a prenatal low-protein diet causes hypertension and a reduction in GFR in mature adult offspring, which can be modified by postnatal rearing.

  2. Circulating CD34-positive cells, glomerular filtration rate and triglycerides in relation to hypertension.

    Science.gov (United States)

    Shimizu, Yuji; Sato, Shimpei; Koyamatsu, Jun; Yamanashi, Hirotomo; Nagayoshi, Mako; Kadota, Koichiro; Maeda, Takahiro

    2015-11-01

    Serum triglycerides have been reported to be independently associated with the development of chronic kidney disease (CKD), which is known to play a role in vascular disturbance. On the other hand, circulating CD34-positve cells, including endothelial progenitor cells, are reported to contribute to vascular repair. However, no studies have reported on the correlation between triglycerides and the number of CD34-positive cells. Since hypertension is well known factor for vascular impairment, the degree of correlation between serum triglycerides and circulating CD34-positve cells should account for hypertension status. We conducted a cross-sectional study of 274 elderly Japanese men aged ≥ 60 years (range 60-79 years) undergoing general health checkups. Multiple linear regression analysis of non-hypertensive subjects adjusting for classical cardiovascular risk factors showed that although triglyceride levels (1SD increments; 64 mg/dL) did not significantly correlate with glomerular filtration rate (GFR) (β = -2.06, p = 0.163), a significant positive correlation was seen between triglycerides and the number of circulating CD34-positive cells (β = 0.50, p = 0.004). In hypertensive subjects, a significant inverse correlation between triglycerides and GFR was observed (β = -2.66, p = 0.035), whereas no significant correlation between triglycerides and the number of circulating CD34-positive cells was noted (β = -0.004, p = 0.974). Since endothelial progenitor cells (CD34-positive cells) have been reported to contribute to vascular repair, our results indicate that in non-hypertensive subjects, triglycerides may stimulate an increase in circulating CD34-positive cells (vascular repair) by inducing vascular disturbance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Comparison between Cystatin C- and Creatinine-Estimated Glomerular Filtration Rate in Cardiology Patients

    Science.gov (United States)

    Åkerblom, Axel; Helmersson-Karlqvist, Johanna; Flodin, Mats; Larsson, Anders

    2015-01-01

    Objective Estimation of the glomerular filtration rate (GFR) is essential for identification, evaluation and risk prediction in patients with kidney disease. Estimated GFR (eGFR) is also needed for the correct dosing of drugs eliminated by the kidneys and to identify high-risk individuals in whom coronary angiography or other procedures may lead to kidney failure. Both cystatin C and creatinine are used for the determination of GFR, and we aimed to investigate if eGFR by the two methods differ in cardiology patients. Methods We compared cystatin C and creatinine (CKD-EPI) eGFR calculated from the same request from a cardiology outpatient unit (n = 2,716), a cardiology ward (n = 980), a coronary care unit (n = 1,464), and an advanced coronary care unit (n = 518) in an observational, cross-sectional study. Results The median creatinine eGFR results are approximately 10 ml/min/1.73 m2 higher than the median cystatin C eGFR that is up to 90 ml/min/1.73 m2, irrespective of the level of care. Creatinine eGFR resulted in a less advanced eGFR category in the majority of patients with a cystatin C eGFR <60 ml/min/1.73 m2. Conclusions Our study demonstrates a difference between creatinine and cystatin C eGFR in cardiology patients. It is important to be aware of which marker is used for the reported eGFR to minimize erroneous interpretations of the test results, as this could lead to under- or overmedication. Further studies are needed to determine the best method of estimating the GFR in cardiology units. PMID:26648945

  4. Application of creatinine- and/or cystatin C-based glomerular filtration rate estimation equations in elderly Chinese

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    Ye XS

    2014-09-01

    Full Text Available Xiaoshuang Ye,1 Lu Wei,1 Xiaohua Pei,1 Bei Zhu,1 Jianqing Wu,2 Weihong Zhao1 1Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 2Division of Respiration, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China Background: No conventional creatinine- or cystatin C-based glomerular filtration rate (GFR estimation equation performed consistently outstandingly in elderly Chinese in our previous studies. This research aimed to further evaluate the performance of some recently proposed estimation equations based on creatinine and cystatin C, alone or combined, in this specific population. Materials and methods: The equations were validated in a population totaling 419 participants (median age 68 [range 60–94] years. The estimated GFR (eGFR calculated separately by ten equations was compared with the reference GFR (rGFR measured by the 99mTc-DTPA renal dynamic imaging method. Results: Median serum creatinine, cystatin C, and rGFR levels were 0.93 mg/L, 1.13 mg/L, and 74.20 mL/min/1.73 m2, respectively. The Chinese population-developed creatinine- and cystatin C-based (Cscr-cys equation yielded the least median absolute difference (8.81 vs range 9.53–16.32, P<0.05, vs the Chronic Kidney Disease Epidemiology Collaboration serum creatinine equation, the highest proportion of eGFR within 15% and 30% of rGFR (P15 and P30, 55.13 and 85.44, P<0.05 and P<0.01, vs the Chronic Kidney Disease Epidemiology Collaboration serum creatinine equation, and the lowest root mean square error (14.87 vs range 15.30–22.45 in the whole cohort. A substantial agreement of diagnostic consistency between eGFR and rGFR (with a kappa 0.61–0.80 was also observed with the Cscr-cys equation. Moreover, measures of performance in the Cscr-cys equation were consistent across normal to mildly

  5. The kinetic basis of glomerular filtration rate measurement and new concepts of indexation to body size

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    Peters, A.M. [Department of Nuclear Medicine, Addenbrooke' s Hospital, Hills Road, Box 170, CB2 2QQ, Cambridge (United Kingdom)

    2004-01-01

    As measurement of glomerular filtration rate (GFR) is now generally the responsibility of departments of nuclear medicine, it is important for nuclear medicine physicians and scientists to understand the pharmacokinetics of the indicators and radiotracers that are used, generally known as filtration markers. The single-injection, non-steady state technique is almost universally used, departments varying in how many blood samples are taken: rarely multisample clearance, which does not assume a single compartment of tracer distribution, commonly clearance based on a limited number of blood samples between 2 and 4 h after injection, which assumes a single compartment of distribution, and often a single sample at a defined time point. The volume of distribution, V{sub d}, of a filtration marker is close to extracellular fluid volume (ECFV). GFR and ECFV are both overestimated by the assumption of a single compartment by amounts that are functions of the rate of plasma clearance, Z. Residence time, T, of tracer in its V{sub d} is equal to V{sub d} divided by Z. Z and T can both be measured from a multisample clearance curve, whereupon V{sub d} is the product of Z and T. GFR is usually indexed to patient size by expressing it in relation to body surface area (BSA), which in turn is calculated from an equation based on the patient's height and weight. An equation in common use was described by Haycock et al. and is BSA=0.024265 x weight{sup 0.5378} x height{sup 0.3964}. An alternative indexation variable is ECFV. GFR per unit ECFV is close to the rate constant, {alpha}{sub 3}, of the terminal exponential of the plasma clearance curve. It is in fact slightly higher than this rate constant by an amount that is a function of the rate constant itself. The discrepancy between GFR/ECFV and {alpha}{sub 3} arises from the development of a concentration gradient between interstitial fluid and plasma, which in turn produces an extrarenal veno-arterial gradient throughout the

  6. Anti-glomerular basement membrane: A rare cause of renal failure in children

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    Indira Agarwal

    2017-01-01

    Full Text Available Anti-glomerular basement membrane (GBM disease is a rare cause of acute renal failure and known to have bad prognosis regarding renal functions recovery and patient survival specially when diagnosed late and presents with severe renal failure that requires dialysis. We report a case of 11-year-old child with acute renal failure secondary to anti-GBM disease and associated with antineutrophil cytoplasmic antibody-positive vasculitis. He was treated with plasmapheresis, steroids, and cyclophosphamide with recovery of his kidney functions.

  7. Relationship between low glomerular filtration rate, hypertension, and microalbuminuria in type 1 diabetes mellitus

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    Vasović Olga

    2005-01-01

    Full Text Available Aim. To investigate the influence of low glomerular filtration rate, as well as of systolic and diastolic hypertension, on microalbuminuria in patients with type 1 diabetes mellitus. Methods. Twenty seven patients with type 1 diabetes mellitus (18 males, 9 females were studied. All of the patients were below 50 years of age. In 93% of the cases, the duration of diabetes was less than 15 years. GFR was determined, after intravenous injection in the lying position, by using a 99m-Tc-DTPA, while microalbuminuria was calculated for the 24-hour urine using the nephelometric immunoassay (30−300 mg/24 h. The patients were divided into 3 groups according to the value of GFR. The values ranged from 90 to 125 ml/min/1.73 m2 were considered normal (in 63% of the patients in group 1, those above that range were considered as hyperfiltration (in 22.2% of the patients in group 2, while those below that range were considered as hypofiltration (in 13.8% of the patient in group 3. Results. Data analyzed with the one-way ANOVA, indicated a significant statistical difference between the 3 groups in the duration of diabetes (p < 0.05, microalbuminuria (p < 0.01, systolic BP (p < 0.01, diastolic BP (p < 0.05, fructosamine (p = 0.50, urea (p < 0.05, creatinine (p = 0.05, and uric acid (p < 0.05. Microalbuminuria correlated with the age of patients (p <0.05 (Spearman's rho, diabetes mellitus duration (p < 0.01, systolic BP (p < 0.05, diastolic BP (p < 0.05, LDL cholesterol (p < 0.05. There was no statistically significant correlation between GFR and the other parameters. Hypertension, microalbuminuria, and the duration of diabetes correlated positively with the reduction of GFR, revealing the most frequent reduction of GFR in the patients with more than 15-year duration of diabetes. Conclusions. Hypertension and low GFR were associated with microalbuminuria in type 1 diabetes, while the duration of diabetes was shown to be the independent risk factor for the

  8. Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients.

    Science.gov (United States)

    De La Higuera, Laura; Riva, Emma; Djade, Codjo Djignefa; Mandelli, Sara; Franchi, Carlotta; Marengoni, Alessandra; Salerno, Francesco; Corrao, Salvatore; Pasina, Luca; Tettamanti, Mauro; Marcucci, Maura; Mannucci, Pier Mannuccio; Nobili, Alessandro

    2014-10-01

    A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m(2), reference group), group 2 with moderately reduced eGFR (30-59 ml/min/1.73 m(2)) and group 3 with severely reduced eGFR (<30 ml/min/1.73 m(2)). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95% CI 1.20-7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95% CI 0.54-1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95% CI 0.92-4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95% CI 1.13-5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.

  9. Effect of benazepril, robenacoxib and their combination on glomerular filtration rate in cats.

    Science.gov (United States)

    King, Jonathan N; Panteri, Alessandro; Graille, Melanie; Seewald, Wolfgang; Friton, Gabriele; Desevaux, Cyril

    2016-06-23

    Combined use of angiotensin-converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs may induce acute kidney injury in humans, especially when combined with diuretics. The objective of this investigation was to evaluate the effects of benazepril, robenacoxib and their combination in healthy cats. In each of two studies (study 1 followed by study 2), 32 healthy cats were randomised to one of four groups (n = 4 male and 4 female cats per group) in a parallel-group design. The groups received orally once daily for 7 days either placebo (control group), benazepril, robenacoxib or benazepril plus robenacoxib. In study 2, all groups received in addition 0.5 mg/kg furosemide twice daily by subcutaneous injection for 7 days. Benazepril, robenacoxib and their combination were well tolerated as evidenced from lack of clinical signs and no negative effects on body weight, feed consumption and clinical chemistry, haematology and urinalysis variables. The primary endpoint of the study was the glomerular filtration rate (GFR), which was estimated from the plasma clearance of iohexol. In the absence of furosemide, GFR was significantly higher in cats receiving the combination of benazepril plus robenacoxib compared to the other three groups, and was also significantly higher in females receiving only benazepril compared to the control. Administration of furosemide induced diuresis, reduced GFR and activated the renin-aldosterone-angiotensin system, evidenced from increased plasma renin activity and plasma aldosterone concentrations. Compared to the control group in cats treated with furosemide, GFR was increased by benazepril (females only) but decreased by robenacoxib (males only). Benazepril, robenacoxib and their combination significantly inhibited the increase in plasma aldosterone induced by furosemide. The combination of benazepril and robenacoxib was well tolerated and either increased or had a neutral effect on GFR in healthy cats without or with

  10. Tubular markers do not predict the decline in glomerular filtration rate in type 1 diabetic patients with overt nephropathy

    DEFF Research Database (Denmark)

    Nielsen, Stine E; Andersen, Steen; Zdunek, Dietmar

    2011-01-01

    Recent studies have shown that both glomerular and tubulointerstitial damage are important factors in the pathophysiology and progression of diabetic nephropathy. To examine whether markers of tubular damage are useful in monitoring the progression of disease, we measured urinary levels...... associated with a faster decline in GFR, but not after adjustment for known promoters of progression. Urinary LFABP was not related to decline in GFR. Losartan treatment (100 mg/day) reduced urinary KIM-1 by 43% over a 12-month period. Thus, urine biomarker measurements in patients with type 1 diabetic...... of neutrophil gelatinase-associated lipocalin (NGAL), liver-fatty acid-binding protein (LFABP), and kidney injury molecule-1 (KIM-1) in a 3-year intervention study of 63 type 1 diabetic patients with kidney disease. The baseline mean glomerular filtration rate (GFR) was 87 ml/min per 1.73 m(2) and urinary...

  11. The clearance concept with special reference to determination of glomerular filtration rate in patients with fluid retention

    DEFF Research Database (Denmark)

    Henriksen, Ulrik L; Henriksen, Jens H

    2014-01-01

    In subjects without fluid retention, the total plasma clearance of a renal filtration indicator (inulin, (99m) Tc-DTPA, (51) Cr-EDTA) is close to the urinary plasma clearance. Conversely, in patients with fluid retention (oedema, pleural effusions, ascites), there is a substantial discrepancy...

  12. Determining true glomerular filtration status in newly presenting type 2 diabetic subjects using age and sex adjustment.

    Science.gov (United States)

    Playle, R; Ollerton, R L; Dunstan, F D; Evans, W D; Burch, A; Luzio, S D; Owens, D R

    1998-11-01

    To determine age- and sex-adjusted reference ranges (ASARRs) for glomerular filtration status using data from nondiabetic subjects and to apply these to newly presenting type 2 diabetic subjects. Glomerular filtration rate corrected for body surface area (cGFR) was determined using a radionuclide (51Cr-EDTA) method in 75 non-diabetic subjects (37 men, 38 women) and 219 type 2 diabetic subjects (157 men, 62 women). The 95% constant reference ranges (CRRs) were calculated as mean nondiabetic cGFR+/-1.96 SD. The 95% ASARRs were calculated by Altman's method from the nondiabetic cGFR versus age regression residuals for both male and female subjects. Using Altman's method, the intercepts, but not the gradients, of the cGFR versus age regressions were significantly different between male and female subjects (intercept difference [95% CI] 8.2 [1.3-15.1], gradient difference -0.4 [-1.1 to 0.3]). Fitting a common gradient, 95% ASARRs for normofiltration were found to be from 123.9 - (0.89 X age) to 181.7 - (0.89 x age) for male subjects, and from 116.0 - (0.89 X age) to 173.2 - (0.89 X age) for female subjects. The 95% CRR for normofiltration was 70.2-138.1 ml x min(-1) x (1.73 m)(-2). When applied to the diabetic cGFRs, the CRRs and ASARRs gave, respectively, 17% (37/219) versus 21% (46/219) hyperfiltrators and 83% (181/219) versus 79% (172/219) normofiltrators. Using the ASARRs, 14 normofiltrators (6 men, 8 women) were reclassified as hyperfiltrators (change [n/total n] [95% CI] 8% [14/181] [4-12]), and 5 hyperfiltrators (5 men, 0 women) were reclassified as normofiltrators (change 14% [5/37] [5-30]). We conclude that age and sex adjustment are essential to assess glomerular filtration status.

  13. Verification on the use of the Inoue method for precisely determining glomerular filtration rate in Philippine pediatrics

    Science.gov (United States)

    Magcase, M. J. D. J.; Duyan, A. Q.; Carpio, J.; Carbonell, C. A.; Trono, J. D.

    2015-06-01

    The objective of this study is to validate the Inoue method so that it would be the preferential choice in determining glomerular filtration rate (GFR) in Philippine pediatrics. The study consisted of 36 patients ranging from ages 2 months to 19 years old. The subjects used were those who were previously subjected to in-vitro method. The scintigrams of the invitro method was obtained and processed for split percentage uptake and for parameters needed to obtain Inoue GFR. The result of this paper correlates the Inoue GFR and In-vitro method (r = 0.926). Thus, Inoue method is a viable, simple, and practical technique in determining GFR in pediatric patients.

  14. Mannitol clearance for the determination of glomerular filtration rate-a validation against clearance of (51) Cr-EDTA.

    Science.gov (United States)

    Kiss, Katalin; Molnár, Miklós; Söndergaard, Sören; Molnár, Gyula; Ricksten, Sven-Erik

    2016-06-03

    We studied the agreement between plasma clearance of mannitol and the reference method, plasma clearance of (51) Cr-EDTA in outpatients with normal to moderately impaired renal function. Forty-one patients with a serum creatinine clearance was measured with the standard bolus injection technique and glomerular filtration rate (GFR) was calculated by the single-sample method described by Jacobsson. Mannitol, 0·25 g kg(-1) body weight (150 mg ml(-1) ), was infused for 4-14 min and blood samples taken at 1-, 2-, 3- and 4-h (n = 24) or 2-, 3-, 3·5- and 4-h after infusion (n = 17). Mannitol in serum was measured by an enzymatic method. Plasma clearance for mannitol and its apparent volume of distribution (Vd) were calculated according to Brøchner-Mortensen. Mean plasma clearance (±SD) for (51) Cr-EDTA was 59·7 ± 18·8 ml min(-1) . The mean plasma clearance for mannitol ranged between 57·0 ± 20·1 and 61·1 ± 16·7 ml min(-1) and Vd was 21·3 ± 6·2% per kg b.w. The between-method bias ranged between -0·23 and 2·73 ml min(-1) , the percentage error between 26·7 and 39·5% and the limits of agreement between -14·3/17·2 and -25·3/19·9 ml min(-1) . The best agreement was seen when three- or four-sample measurements of plasma mannitol were obtained and when sampling started 60 min after injection. Furthermore, accuracy of plasma clearance determinations was 88-96% (P30) and 41-63% (P10) and was highest when three- or four-sample measurements of plasma mannitol were obtained, including the first hour after the bolus dose. We conclude that there is a good agreement between plasma clearances of mannitol and (51) Cr-EDTA for the assessment of GFR.

  15. Cystatin C, vascular biomarkers and measured glomerular filtration rate in patients with unresponsive hypertensive phenotype: a pilot study.

    Science.gov (United States)

    Čabarkapa, Velibor; Ilinčić, Branislava; Đerić, Mirjana; Vučaj Ćirilović, Viktorija; Kresoja, Milena; Žeravica, Radmila; Sakač, Vladimir

    2017-11-01

    Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest. Participants (n = 200, median age 58 (52-64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT - compliant and responsive to treatment, n = 100), or nonresponsive (URHT - compliant but nonresponsive to treatment, n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid - mGFR). The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m(2), p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04). In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship.

  16. Comparison of three empirical formulae for calculating the glomerular filtration rate of patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Xiao-mei LUO

    2011-07-01

    Full Text Available Objective To compare the values of 3 empirical formulae,namely Modification of Diet in Renal Disease(MDRD study equation,Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI equation,and cystatin C(Cys C single variable equations(eGFR-Cys,on predicting the glomerular filtration rate(GFR of patients with chronic kidney disease.Methods Ninety three patients with chronic kidney disease were enrolled in present study.The plasma clearance of 99mTc-diethylenetriamine pentaacetic acid(DTPA was measured the golden standard of GFR(rGFR,and estimated GFR(eGFR was calculated with the MDRD equation,CKD-EPI equation and eGFR-Cys equation,respectively.The result of rGFR with that of various eGFR was compared.Results Compared with rGFR,the mean bias of eGFR in CKD-EPI equation,eGFR-Cys equation and MDRD study equation were-3.4±10.7ml/(min·1.73m2,-4.8±11.9ml/(min·1.73m2 and-5.4±10.4ml/(min·1.73m2,respectively,and no significant difference was noted among the 3 values.The 30% accuracy of 3 equations was 74.2%,72.0% and 64.5%,respectively,no significant difference was found among the 3 values.The 30% accuracy of CKD-EPI equation was higher than that of MDRD study equation(75.7%±5.1% vs 54.1%±7.7%,P 60ml/(min·1.73m2.With 60ml/(min·1.73m2 as the diagnostic cut-off point of GFR damage,the area under receiver operating characteristic(ROC curve was 0.862 in MDRD study equation,0.863 in CKD-EPI equation and 0.877 in eGFR-Cys equation,respectively,and no significant difference was found among the 3 values.Conclusions There are no significant differences among the 3 equations in predicting the GFR of patients with CKD.However,further studies are needed to investigate whether MDRD study equation could be replaced by the CKD-EPI equation and eGFR-Cys equation.

  17. Association of Microalbuminuria and Estimated Glomerular Filtration Rate With Carotid Intima-Media Thickness in Patients With Type 2 Diabetes Mellitus

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    Dehdashti Shahrokh

    2015-04-01

    Full Text Available Background Atherosclerosis is the main cause of cardiovascular diseases, and its risk enhances in type 2 diabetes mellitus. Objectives This study aimed to evaluate Carotid Intima-Media Thickness (CIMT by carotid artery ultrasonography and assess its correlation with microalbuminuria and estimated Glomerular Filtration Rate (eGFR in the patients with type 2 diabetes mellitus. Patients and Methods This cross-sectional study was included 205 patients with Type 2 Diabetes Mellitus (T2DM. We recorded clinical and biochemical data such as FBS, lipid profile, and urinary albumin. Intima-media thickness of carotid arteries was measured in all patients by high frequency ultrasound. Results In simple correlation coefficients analysis, CIMT was significantly associated with total cholesterol (r = 0.197, P = 0.008, serum creatinine (r = 0.240, P = 0.001, and urinary albumin (r = 0.420, P = 0.000. Also, CIMT elevated significantly with the stage progression of chronic kidney disease (0.67 ± 0.15 mm in stage 1, 0.73 ± 0.22 mm in stage 2, and 0.82 ± 0.21 mm in stage 3 (P value = 0.024. In multivariate linear regression analysis, the duration of diabetes, weight, HDL, serum creatinine, urinary albumin, and estimated Glomerular Filtration Rate (eGFR were independently associated with CIMT (P value < 0.05 for all. Conclusions Our study shows a relationship between CIMT and renal parameters, including eGFR and albuminuria. This study confirms the importance of intensive examinations for early detection of atherosclerosis and treatment of risk factors.

  18. Polymorphisms in the non-muscle myosin heavy chain gene (MYH9 are associated with lower glomerular filtration rate in mixed ancestry diabetic subjects from South Africa.

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    Tandi Edith Matsha

    Full Text Available OBJECTIVE: Though single nucleotide polymorphisms (SNPs in the non-muscle myosin gene (MYH9 have been reported to explain most of the excess risk of nondiabetic chronic kidney disease (CKD, in African-Americans, some studies have also shown associations with diabetic end-stage renal disease. We investigated the association of MYH9 SNPs with renal traits in a mixed-ancestry South African population prone to diabetes. RESEARCH DESIGN AND METHODS: Three SNPs known to be associated with CKD (rs4821480, rs5756152 and rs12107 were genotyped using Taqman assay in 716 adults (198 with diabetes from the Bellville-South community, Cape Town. Glomerular filtration rate was estimated (eGFR and urinary albumin/creatinine ratio (ACR assessed. Multivariable regressions were used to relate the SNPs with renal traits. RESULTS: Mean age was 53.6 years, with the expected differences observed in characteristics by diabetic status. Significant associations were found between rs575152 and serum creatinine, and eGFR in the total population, and in diabetic participants (all p≤0.003, but not in non-diabetics (all p≥0.16, with significant interactions by diabetes status (interaction-p≤0.009. The association with ACR was borderline in diabetic participants (p = 0.05 and non-significant in non-diabetics (p = 0.85, with significant interaction (interaction p = 0.02. rs12107 was associated with fasting-, 2-hour glucose and HbA1c in diabetic participants only (interaction-p≤0.003, but not with renal traits. CONCLUSION: MYH9 SNPs were associated with renal traits only in diabetic participants in this population. Our findings and other studies suggest that MYH9 may have a broader genetic risk effect on kidney diseases.

  19. Glomerular filtration rate by {sup 51}chomium and {sup 113m}indium labeled EDTA in horses; Taxa de filtracao glomerular pelo EDTA marcado com {sup 51}cromo e com {sup 113m}indio em equinos

    Energy Technology Data Exchange (ETDEWEB)

    Maliska, C.; D' Almeida, J.; Pellegrini, P.M.; Schimit, T.S. [Hospital Central do Exercito (HCE), Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear; Pinho, W.R. [Centro de Ensino Superior, Valenca, RJ (Brazil). Fac. de Medicina Veterinaria; Lima, J.E.T. [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear

    2009-07-01

    The glomerular filtration rate was determined in nine healthy horses, six male and three female, aged two to 12-year-old, by means of {sup 51}Cr and {sup 113m}In labeled EDTA single injection technique. The glomerular filtration rate was calculated from the plasma disappearance curve and the volume of distribution of the radiotracer, {sup 51}Cr-EDTA or {sup 113m}In-EDTA. The result (mean +- standard deviation) was 148.80 +- 26.42 m L.min{sup -1}.100 kg. It is concluded that the measurement of glomerular filtration rate by {sup 51}Cr-EDTA or {sup 113m}In-EDTA by single injection technique eliminates the bladder catheterization, and for its simplicity, convenience, accuracy, and low dose of radiation, can be used in horses as a method of choice in clinical routine. (author)

  20. The tetraspanin CD37 protects against glomerular IgA deposition and renal pathology.

    Science.gov (United States)

    Rops, Angelique L; Figdor, Carl G; van der Schaaf, Alie; Tamboer, Wim P; Bakker, Marinka A; Berden, Jo H; Dijkman, Henry B P M; Steenbergen, Eric J; van der Vlag, Johan; van Spriel, Annemiek B

    2010-05-01

    The tetraspanin protein CD37 is a leukocyte-specific transmembrane protein that is highly expressed on B cells. CD37-deficient (CD37(-/-)) mice exhibit a 15-fold increased level of immunoglobulin A (IgA) in serum and elevated numbers of IgA+ plasma cells in lymphoid organs. Here, we report that CD37(-/-) mice spontaneously develop renal pathology with characteristics of human IgA nephropathy. In young naïve CD37(-/-) mice, mild IgA deposition in glomeruli was observed. However, CD37(-/-) mice developed high titers of IgA immune complexes in serum during aging, which was associated with increased glomerular IgA deposition. Severe mesangial proliferation, fibrosis, and hyalinosis were apparent in aged CD37(-/-) mice, whereas albuminuria was mild. To further evaluate the role of CD37 in glomerular disease, we induced anti-glomerular basement membrane (GBM) nephritis in mice. CD37(-/-) mice developed higher IgA serum levels and glomerular deposits of anti-GBM IgA compared with wild-type mice. Importantly, glomerular macrophage and neutrophil influx was significantly higher in CD37(-/-) mice during both the heterologous and autologous phase of anti-GBM nephritis. Taken together, tetraspanin CD37 controls the formation of IgA-containing immune complexes and glomerular IgA deposition, which induces influx of inflammatory myeloid cells. Therefore, CD37 may protect against the development of IgA nephropathy.

  1. The Spectrum of Glomerular Diseases on Renal Biopsy: Data From A Single Tertiary Center In Oman

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    Dawood Al Riyami

    2013-05-01

    Full Text Available Objective: To study the pattern of glomerular disease (GD from the result of renal biopsies at our center.Methods: We conducted a retrospective review of 190 adult native renal biopsy reports from the pathology registry of renal biopsy performed at our hospital between 1992 and 2010.Results: Lupus nephritis was the most common pathology 48/133 (36.1% with a female preponderance. The most common primary glomerular disease was focal segmental glomerulosclerosis (FSGS 26/133(19.5%, followed by membranous glemerulopathy (MGN 13/133 (9.8%, and mesangial proliferative glomerulonephritis 6/133 (4.5%. IgA nephropathy and acute proliferative glomerulonephritis each accounted for 4/133 (3.0%. Membranoproliferative glomerulonephritis accounted for 3/133 (2.3%. Focal proliferative and cresentic glomerulonephritis each accounted for 2/133 (1.5%. Vasculitis was not common and there was no report of anti-GBM disease.Conclusion: Among the secondary glomerular diseases, lupus nephritis was the commonest condition with a female preponderance. Among the primary glomerular diseases, FSGS was the commonest. These results are consistent with global trend. IgA nephropathy is not common as the case in the Caucasian population. Vasculitis was not common and there was no report of anti-GBM disease.

  2. Arterial hypertension treated with angiotensin converting enzyme inhibitors and glucocorticoids are independent risk factors associated with decreased glomerular filtration rate in systemic sclerosis.

    Science.gov (United States)

    Ostojic, Predrag; Stojanovski, Natasa

    2017-03-01

    The aim of this study was to estimate prevalence and severity of renal insufficiency in systemic sclerosis (SSc) and to assess risk factors associated with reduced glomerular filtration rate (GFR) in SSc patients. Seventy-three consecutive patients with SSc (67 women and 6 men), mean age 56.2 years, mean disease duration 6.7 years, were included in this cross-sectional study. GFR was measured by creatinine clearance (CCr) in all patients, as well as 24-h proteinuria. We assessed frequency and severity of renal insufficiency in our patients with SSc and estimated the association of renal insufficiency with age, disease duration, subtype of the disease, earlier diagnosed arterial hypertension, and medications for which we assumed to affect renal function-cytostatics, nonsteroidal anti-inflammatory drugs, glucocorticoids, ACE inhibitors, diuretics, and calcium channel blockers (CCB). Fifty-six out of 73 patients with SSc (76.7%) had reduced GFR (CCr lower than 90 ml/min), compared to 17/73 (23.3%) of patients with normal renal function. Mild renal insufficiency was noticed in 28/73 (38.4%), moderate in 21/73 (28.8%) and severe renal insufficiency in 5/73 (6.8%). End-stage renal disease (CCr arterial hypertension and treatment with glucocorticoids are independent risk factors for reduced GFR. On the other hand, age, disease duration, disease form, as well as antibodies (anticentromere antibodies-ACA and anti-topoisomerase I antibodies-ATA) were excluded as independent risk factors. Patients with SSc and arterial hypertension treated with CCB had significantly higher mean CCr than patients treated with diuretics (90.4 vs 53.5 ml/min, p = 0.03), or patients treated with ACE inhibitors (90.4 vs 41.7 ml/min, p = 0.001). Decreased GFR is common in SSc. Most of patients have mild or moderate renal insufficiency. Previously diagnosed arterial hypertension, especially when treated with ACE inhibitors or diuretics, and glucocorticoids are independent risk factors

  3. Comparison of the performance of the updated Schwartz, combined Schwartz and the Grubb glomerular filtration rate equations in a general pediatric population.

    Science.gov (United States)

    Gheissari, Alaleh; Roomizadeh, Peyman; Kelishadi, Roya; Abedini, Amin; Haghjooy-Javanmard, Shaghayegh; Abtahi, Seyed-Hossein; Mehdikhani, Bahareh

    2014-09-01

    To determine the performance of the updated Schwartz, combined Schwartz and Grubb glomerular filtration rate (GFR) equations in a relatively large number of healthy children with no known renal disease, we studied 712 students aged between seven and 18 years from the Isfahan province of Iran by random cluster sampling between 2009 and 2010. Blood investigations included blood urea nitrogen, creatinine and cystatin C. For each participant, GFR was calculated based on the three equations. We used Bland-Altman plots and weighted kappa statistics to compare the performance of the study equations. The mean age of the children was 12.2 ± 2.4 years. A high concordance in estimating GFR (mean difference: 0 ± 12.7 mL/min/1.73 m 2 ) and a very good agreement in defining chronic kidney disease (CKD) and non-CKD individuals (weighted kappa: 0.85; 95% confidence intervals: 0.69-1) were observed between the updated Schwartz and the combined Schwartz equations. Poor agreement was observed between the Grubb equation and two Schwartz equations in estimating GFR and defining CKD. There was no systematic deviation between the updated Schwartz and the combined Schwartz equations in children with normal renal function. The Grubb equation was highly inconsistent with both Schwartz equations in this population. We conclude that the updated Schwartz equation is simpler and more accessible than the combined Schwartz equation in daily clinical practice and CKD screening programs.

  4. Comparison of the performance of the updated Schwartz, combined Schwartz and the Grubb glomerular filtration rate equations in a general pediatric population

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    Alaleh Gheissari

    2014-01-01

    Full Text Available To determine the performance of the updated Schwartz, combined Schwartz and Grubb glomerular filtration rate (GFR equations in a relatively large number of healthy children with no known renal disease, we studied 712 students aged between seven and 18 years from the Isfahan province of Iran by random cluster sampling between 2009 and 2010. Blood investigations included blood urea nitrogen, creatinine and cystatin C. For each participant, GFR was calculated based on the three equations. We used Bland-Altman plots and weighted kappa statistics to compare the performance of the study equations. The mean age of the children was 12.2 ± 2.4 years. A high concordance in estimating GFR (mean difference: 0 ± 12.7 mL/min/1.73 m 2 and a very good agreement in defining chronic kidney disease (CKD and non-CKD individuals (weighted kappa: 0.85; 95% confidence intervals: 0.69-1 were observed between the updated Schwartz and the combined Schwartz equations. Poor agreement was observed between the Grubb equation and two Schwartz equations in estimating GFR and defining CKD. There was no systematic deviation between the updated Schwartz and the combined Schwartz equations in children with normal renal function. The Grubb equation was highly inconsistent with both Schwartz equations in this population. We conclude that the updated Schwartz equation is simpler and more accessible than the combined Schwartz equation in daily clinical practice and CKD screening programs.

  5. Reduced glomerular filtration rate, inflammation and HDL cholesterol as main determinants of superoxide production in non-dialysis chronic kidney disease patients.

    Science.gov (United States)

    Morena, Marion; Patrier, Laure; Jaussent, Isabelle; Bargnoux, Anne-Sophie; Dupuy, Anne-Marie; Badiou, Stéphanie; Leray-Moragues, Hélène; Klouche, Kada; Canaud, Bernard; Cristol, Jean-Paul

    2011-06-01

    Enhanced oxidative stress partly resulting from an over-production of superoxide anion (O(2)(•-)) represents a novel and particular risk factor in chronic kidney disease (CKD) patients. This study was therefore designed to evaluate O(2)(•-) determinants in this population. O(2)(•-) production was evaluated using chemiluminescence method in 136 CKD patients (79M/57F, median age: 69.5 [27.4-94.6]). Renal function (evaluated by the glomerular filtration rate using modification of diet in renal disease (MDRD)), inflammation, lipids, nutritional and bone mineral as well as clinical parameters were evaluated. Potential relationships between O(2)(•-) and these clinico-biological parameters were investigated to identify main determinants of such a pathological process. Enhanced O(2)(•-) production has been observed at the pre-dialysis phase: stages 4 and 5 of CKD (p = 0.0065). In multivariate analysis, low eGFR (MDRD <30 mL/min/1.73 m(2); p = 0.046), high fibrinogen (≥3.7 g/L; p = 0.044) and abnormal HDL cholesterol (<1.42 mmol/L and ≥ 1.75 mmol/L; p = 0.042) were the main determinants of O(2)(•-) production in CKD patients.

  6.  A Comparison of Serum Cystatin C and Creatinine with Glomerular FiltrationRate in Indian Patients with Chronic Kidney Disease

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    Ramanathan Kumaresan

    2011-11-01

    Full Text Available  Objectives: There is no literature available on the performance of cystatin C in Chronic Kidney Disease (CKD patients of Indian population based on age group. Hence, this study is aimed to compare the diagnostic performance of serum cystatin C and creatinine with measured glomerular filtration rate (GFR and estimated GFR (eGFR in subjects of Indian origin. Methods: The study was carried out at Tiruchirappalli, South India during the period of September 2010 to march 2011. One hundred and six CKD patients (82 males, 24 females were enrolled and categorized into three groups based on age. The eGFR was calculated using Cockcroft-Gault (CG and Modification of Diet in Renal Disease (MDRD formulae. Serum cystatin C was measured with a particle-enhanced nephelometric immunoassay (PENIA method. GFR was measured using 99mTC - diethylene triamine penta aceticacid (DTPA renal scan method. Results: Serum cystatin C showed significant correlation with measured GFR in all the three groups (r=-0.9735, r=-0.8975 and r=-0.7994 respectively than serum creatinine (r=-0.7380, r=- 0.6852 and r=-0.5127 respectively. Conclusion: Serum cystatin C showed a high correlation with measured GFR in young and older patients with CKD than creatinine. Thus, cystatin C is a good alternative marker to creatinine in CKD patients.

  7. Simple Cystatin C Formula for Estimation of Glomerular Filtration Rate in Overweight Patients with Diabetes Mellitus Type 2 and Chronic Kidney Disease

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    Sebastjan Bevc

    2012-01-01

    Full Text Available In clinical practice the glomerular filtration rate (GFR is estimated from serum creatinine-based equations like the Cockcroft-Gault formula (C&G and Modification of Diet in Renal Disease formula (MDRD. Recently, serum cystatin C-based equations, the newer creatinine formula (The Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI, and equation that use both serum creatinine and cystatin C (CKD-EPI creatinine & cystatin formula were proposed as new GFR markers. Present study compares serum creatinine-based equations, combined (including both serum creatinine and cystatin C equation, and serum simple cystatin C formula (100/serum cystatin C against 51CrEDTA clearance in 113 adult overweight Caucasians with diabetes mellitus type 2 (DM2 and chronic kidney disease (CKD. The results of present study demonstrated that the simple cystatin C formula could be a useful tool for the evaluation of renal function in overweight patients with DM2 and impaired kidney function in daily clinical practice in hospital and especially in outpatients. Despite the advantages of the simple cystatin C formula, cystatin C-based equations cannot completely replace the “gold standard” for estimation of the GFR in a population of DM2 patients with CKD, but may contribute to a more accurate selection of patients requiring such invasive and costly procedures.

  8. Zika Virus Infection of the Human Glomerular Cells: Implications for Viral Reservoirs and Renal Pathogenesis.

    Science.gov (United States)

    Alcendor, Donald J

    2017-07-15

    Zika virus (ZIKV) infection in the human renal compartment has not been reported. Several clinical reports have describe high-level persistent viral shedding in the urine of infected patients, but the associated mechanisms have not been explored until now. The current study examined cellular components of the glomerulus of the human kidney for ZIKV infectivity. I infected primary human podocytes, renal glomerular endothelial cells (GECs), and mesangial cells with ZIKV. Viral infectivity was analyzed by means of microscopy, immunofluorescence, real-time reverse-transcription polymerase chain reaction (RT-PCR), and quantitative RT-PCR (qRT-PCR), and the proinflammatory cytokines interleukin 1β, interferon β, and RANTES (regulated on activation of normal T cells expressed and secreted) were assessed using qRT-PCR. I show that glomerular podocytes, renal GECs, and mesangial cells are permissive for ZIKV infection. ZIKV infectivity was confirmed in all 3 cell types by means of immunofluorescence staining, RT-PCR, and qRT-PCR, and qRT-PCR analysis revealed increased transcriptional induction of interleukin 1β, interferon β, and RANTES in ZIKV-infected podocytes at 72 hours, compared with renal GECs and mesangial cells. The findings of this study support the notion that the glomerulus may serve as an amplification reservoir for ZIKV in the renal compartment. The impact of ZIKV infection in the human renal compartment is unknown and will require further study.

  9. High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum

    NARCIS (Netherlands)

    Paauw, N.D.; Joles, J.A.; Drost, J.T.; Verhaar, M.C.; Franx, A.; Navis, G.; Maas, A.H.E.M.; Lely, A.T.

    2016-01-01

    Women with a history of preeclampsia have a 5- to 12-fold increased risk to develop end-stage kidney disease. Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal

  10. High-Normal Estimated Glomerular Filtration Rate in Early-Onset Preeclamptic Women 10 Years Postpartum

    NARCIS (Netherlands)

    Paauw, Nina D.; Joles, Jaap A.; Drost, Jose T.; Verhaar, Marianne C.; Franx, Arie; Navis, Gerjan; Maas, Angela H. E. M.; Lely, A. Titia

    2016-01-01

    Women with a history of preeclampsia have a 5- to 12-fold increased risk to develop end-stage kidney disease. Previous observations in small cohorts suggest that former preeclamptic (fPE) women have subtle abnormalities in renal hemodynamics and renal function, which might predispose them to renal f

  11. Cistatina C e taxa de filtração glomerular em cirurgia cardíaca com circulação extracorpórea Cystatin C and glomerular filtration rate in the cardiac surgery with cardiopulmonary bypass

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    Marcello Laneza Felicio

    2009-09-01

    Full Text Available OBJETIVO: Avaliar a cistatina C como marcador de função renal em pacientes submetidos à cirurgia de cardíaca com circulação extracorpórea, comparando com a dosagem sérica de creatinina. MÉTODOS: Foram analisados 50 pacientes consecutivos submetidos à cirurgia de revascularização do miocárdio. A função renal foi avaliada com a dosagem sérica de cistatina C e de creatinina no pré-operatório, no primeiro e no quinto dia de pós-operatório. Foram utilizadas as fórmulas de Cockcroft-Gault (CG e Modification of Diet in Renal Disease (MDRD para calcular a taxa de filtração glomerular estimada (TFG através da creatinina, e a fórmula de Larsson para a TFG estimada através da cistatina C (TFG-Cis. RESULTADOS: A creatinina e o TFG através das fórmulas de CG e MDRD não mostraram diferença significativa nos momentos estudados. Após a agressão renal pela cirurgia, houve um aumento da cistatina C no 1º e 5º pós-operatório, sendo que no 5º pós-operatório com diferença estatisticamente significativa (P OBJECTIVE: The aim of this study was to compare cystatin C versus creatinine as a marker for acute kidney injury in patients submitted to cardiac surgery with cardiopulmonary bypass. METHODS: Fifty consecutive patients submitted to coronary artery bypass grafting were studied. Renal function was evaluated by serum cystatin C and creatinine. Blood samples were obtained from each patient at three time points: before operation, and on the first and fifth postoperative days. Glomerular filtration rate (GFR was calculated by Cockcroft-Gault (CG, Modification of Diet in Renal Disease (MDRD, and Larsson (Cys-GFR formulas. RESULTS: Creatinine and GFR by CG and MDRD formulas did not show statistical difference between study times. After renal injury from surgery, there was an increase in cystatin C on the 1st and 5th day after surgery, being significantly different on the 5th postoperative (P<0.01. The GFR by Larson formula was higher

  12. Impact of nucleos(t)ide analogues on the estimated glomerular filtration rate in patients with chronic hepatitis B: a prospective cohort study in China.

    Science.gov (United States)

    Qi, X; Wang, J-Y; Mao, R-C; Zhang, J-M

    2015-01-01

    Chronic hepatitis B therapy with nucleos(t)ide analogues, particularly tenofovir or adefovir, may affect renal function. To date, there has not been a head-to-head controlled study to assess estimated glomerular filtration rate (eGFR) fluctuations in nucleos(t)ide-treated CHB patients. We aimed to evaluate the long-term effects of nucleos(t)ide on eGFR in Chinese patients with chronic hepatitis B. This prospective cohort study included 275 patients. Patient subgroups included those treated with lamivudine (n = 50), adefovir (n = 60), telbivudine (n = 68) and entecavir (n = 61); untreated patients (n = 36) served as control. After an average follow-up duration of 23 months, eGFR calculated by Cockcroft-Gault and Modification of Diet in Renal Disease formulas increased by 18.35 mL/min and 19.34 mL/min (P < 0.0001) in the telbivudine group, respectively, and decreased by 10.95 mL/min and 12.17 mL/min (P = 0.0001) in the adefovir group, respectively. Even if renal function was normal or mildly impaired at baseline, eGFR increased significantly more in the telbivudine group than in the other groups (P < 0.001). More patients in the adefovir group (23%) had a ≥20% decrease in eGFR than the other groups (P < 0.0001). More patients in the telbivudine group (31%) had a ≥20% increase in eGFR than the other groups (P < 0.0001). In conclusion, prolonged telbivudine therapy resulted in improved eGFR, while adefovir therapy was associated with decreased eGFR. Lamivudine and entecavir therapy did not significantly influence eGFR.

  13. Use of spiral CT and the contrast medium iohexol to determine in one session aortorenal morphology and the relative glomerular filtration rate of each kidney

    Energy Technology Data Exchange (ETDEWEB)

    Frennby, B.; Almen, T. [Malmoe Allmaenna Sjukhus (Sweden). Dept. of Radiology

    2001-11-01

    The aim of this study was to determine the relative glomerular filtration rate (GFR), i.e. the GFR of each kidney in percent of total GFR, by spiral CT. In 41 patients, who were part of a follow-up program after endoluminal stent grafting of aortic aneurysm, spiral CT with the contrast medium iohexol was used to evaluate the morphology of the aorta and kidneys. The opportunity was taken to utilize the already injected iohexol to determine the relative GFR with an extra CT sequence. In each patient two determinations were made, 6 or 12 months apart. The amount of a GFR marker accumulating in Bowman's space, tubuli, and renal pelvis within 2-3 min after i.v. injection, before any marker had left the kidney via the ureter, was defined as proportional to the GFR of that kidney. The renal accumulation of iohexol was obtained by spiral CT using 10-mm collimation and a table speed of 10 mm/s (pitch ratio 1:1) from the upper to the lower poles. The correlation coefficient between the relative GFR of each kidney determined at the first and second examination was excellent (r=0.99) with a median (range) difference of 1% (0-6%) of total GFR. The radiation dose calculated as the mean absorbed dose to the kidneys was 50 mGy and the effective dose 5 mSv. The morphology of aorta and kidneys and the relative GFR of each kidney can be determined in one session with spiral CT using iohexol as both angiographic contrast medium and as a GFR marker. It is also possible to take some plasma samples in the same session to determine iohexol concentration to calculate the body clearance of iohexol (or take plasma and urine samples to calculate the renal clearance of iohexol). (orig.)

  14. Late acceleration of glomerular filtration rate decline is a risk for hemodialysis catheter use in patients with established nephrology chronic kidney disease care.

    Science.gov (United States)

    Chin, Andrew I; Nguyen, Tuan A; Dinesh, Kumar P; Morfin, José A

    2015-07-01

    Chronic kidney disease (CKD) patients with established nephrology care have a high rate of tunneled dialysis catheters (TDC) as first vascular access when transitioning to hemodialysis (HD). We sought to identify factors associated with this problem. Patients who started HD and had prior CKD care within our renal clinic were categorized according to access type at incident HD. Clinical factors, all estimated glomerular filtration rates (eGFR), renal clinic attendance records, hospital admissions in the 6 months preceding HD start, and patient participation in predialysis education course were analyzed. Three hundred thirty-eight patients initiated HD, 107 received pre-HD CKD care within our clinics. Seventy patients started with a TDC. All groups started HD at similar eGFR values. The trajectory of eGFR decline in the 6 months prior to HD start was significantly more rapid in the TDC group. Patients in the TDC group had more acute health events in the prior 6 months. Multivariate modeling showed that failure to attend a predialysis education course and having a more rapid rate of eGFR decline in the 6 months prior to dialysis initiation were both associated with TDC use. Patients with CKD nephrology care who initiated HD with a TDC as first vascular access had a more rapid rate of decline in eGFR in the months preceding dialysis start and were less likely to have attended our predialysis education course. This appears to correspond with the observed increased number of emergency and hospital visits in the 6 months prior to end-stage renal disease.

  15. A prospective study of glomerular filtration rate and arterial blood pressure in insulin-dependent diabetics with diabetic nephropathy

    DEFF Research Database (Denmark)

    Parving, H H; Smidt, U M; Friisberg, B

    1981-01-01

    nephropathy. Twelve of the 14 patients had normal serum creatinine levels. None of the patients received antihypertensive treatment. During the mean observation period of 26 months (range 23 to 33 months) GFR decreased from 107 to 87 ml/min/1.73 m2 (p less than 0.001), serum creatinine remained unchanged: 107...... in arterial blood pressure to a hypertensive level is an early feature of diabetic nephropathy in young insulin-dependent diabetics.......Glomerular filtration rate (GFR, single bolus 51Cr-EDTA technique), serum creatinine, proteinuria and arterial blood pressure have been measured prospectively in 14 young onset insulin-dependent diabetics selected by of persistent proteinuria (greater than 0.5 g/day) secondary to diabetic...

  16. Diagnostic accuracy of various glomerular filtration rates estimating equations in patients with chronic kidney disease and diabetes

    Institute of Scientific and Technical Information of China (English)

    LI Hai-xia; XU Guo-bin; WANG Xue-jing; ZHANG Xu-chu; YANG Jian-mei

    2010-01-01

    Background The equations for estimating glomerular filtration rate (GFR) based on creatinine have been found to have limitations and have not been generalizable across all populations. Equations based on cystatin C provide an alternative method to estimate GFR. Whether the equation based on cystatin C alone or combined creatinine would improve GFR estimates has not been validated among Chinese patients with chronic kidney disease (CKD) and diabetes. The aim of this study was to compare the performance of the modification of diet in renal disease (MDRD) equation based on creatinine with the five cystatin C-based formulae for estimation of GFR in patients with CKD and diabetes. Methods A total of 166 patients with CKD and 91 patients with type 2 diabetes were enrolled in this study. Cystatin C was measured by using the particle-enhanced immunonephelometric method and estimated formulae proposed by five different investigator teams (Stevens, Ma, Rule, Macisaac and Perkins). The plasma clearance of ~(99m)Tc-DTPA was determined as measured GFR (mGFR).Results For CKD patients, the bias and accuracy for the Ma and Macisaac equations were superior compared with the MDRD, and the mean results for the Ma formula were closer to mGFR than the other equations in CKD stages 2-5. The differences between Macisaac and mGFR in CKD stages 2-4 were significantly less than those in CKD stage 1 or 5.Stevens and Rule's formulae revealed a similar bias and accuracy compared with the MDRD equation. The MDRD formula had a higher accuracy in CKD stages 3-5 as compared with the results in other stages. For diabetic patients, the mean results between Macisaac and mGFR were closer than those of other equations in mGFR≥90 ml.min~(-1).1.73 m~(-2) stage, in GFR 60-89 ml·min~(-1)·1.73 m~(-2) stage, the MDRD formula showed the smallest difference compared with other equations. All equations overestimated GFR in the cases with GFR <60 mi.min~(-1)·1.73 m~(-2) stages. The MDRD formula had a

  17. Focused ultrasound-modulated glomerular ultrafiltration assessed by functional changes in renal arteries.

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    Feng-Yi Yang

    Full Text Available This study demonstrates the feasibility of using focused ultrasound (FUS to modulate glomerular ultrafiltration by renal artery sonication and determine if protein-creatinine ratios are estimated through vascular parameters. All animal experiments were approved by our Animal Care and Use Committee. The renal arteries of Sprague-Dawley rats were surgically exposed and sonicated at various acoustic power levels using a FUS transducer with a resonant frequency of 1 MHz. The mean peak systolic velocity (PSV of the blood flow was measured by Doppler ultrasound imaging. Urinary protein-creatinine ratios were calculated during the experiments. Histological examination of renal arteries and whole kidneys was performed. The PSV, pulsatility index, and resistance index of blood flow significantly increased in the arteries after FUS sonication without microbubbles (p<0.05. The change in normalized protein-creatinine ratios significantly increased with increasing acoustic power, but such was not observed when microbubbles were administered. Furthermore, no histological changes were observed in the hematoxylin- and eosin-stained sections. Glomerular ultrafiltration is regulated temporarily by renal artery sonication without microbubbles. Monitoring vascular parameters are useful in estimating the normalized change in protein-creatinine ratios.

  18. A comparison of estimated glomerular filtration rates using Cockcroft-Gault and the Chronic Kidney Disease Epidemiology Collaboration estimating equations in HIV infection

    DEFF Research Database (Denmark)

    Mocroft, A; Nielsen, Lene Ryom; Reiss, P

    2014-01-01

    The aim of this study was to determine whether the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)- or Cockcroft-Gault (CG)-based estimated glomerular filtration rates (eGFRs) performs better in the cohort setting for predicting moderate/advanced chronic kidney disease (CKD) or end...

  19. Physical Activity Is not Associated with Estimated Glomerular Filtration Rate among Young and Middle-Aged Adults : Results from the Population-Based Longitudinal Doetinchem Study

    NARCIS (Netherlands)

    Herber-Gast, Gerrie-Cor M.; Hulsegge, Gerben; Hartman, Linda; Verschuren, W. M. Monique; Stehouwer, Coen D. A.; Gansevoort, Ron T.; Bakker, Stephan J. L.; Spijkerman, Annemieke M. W.

    2015-01-01

    There is debate as to whether physical inactivity is associated with reduced kidney function. We studied the prospective association of (changes in) physical activity with estimated glomerular filtration rate (eGFR) in adult men and women. We included 3,935 participants aged 26 to 65 years from the

  20. Coffee and tea consumption in relation to estimated glomerular filtration rate : results from the population-based longitudinal Doetinchem Cohort Study

    NARCIS (Netherlands)

    Herber-Gast, Gerrie-Cor M.; van Essen, Hanneke; Verschuren, W. M. Monique; Stehouwer, Coen D. A.; Gansevoort, Ron T.; Bakker, Stephan J. L.; Spijkerman, Annemieke M. W.

    2016-01-01

    Background: Although coffee consumption and tea consumption have been linked to diabetes, the relation with kidney function is less clear and is underresearched. Objective: We investigated the prospective associations of coffee and tea consumption with estimated glomerular filtration rate (eGFR). De

  1. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  2. Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.

    Directory of Open Access Journals (Sweden)

    Patrícia Santiago

    Full Text Available With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR of decreased GFR (defined as <60 mL/min/1.73 m(2 was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6% had a GFR between 60 and 89 mL/min/1.73 m(2, 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR <15. Decreased GFR was found in only 74 patients (3.8%. In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m(2 were as follows: age ≥ 50 years (PR = 3.4; 95% CI: 1.7-6.8, diabetes (PR = 2.0; 95% CI: 1.2-3.4, hypertension (PR = 2.0; 95% CI: 1.3-3.2, current CD4+ cell count <350 cells/mm3 (PR = 2.1; 95% CI: 1.3-3.3, past exposure to tenofovir (PR = 4.7; 95% CI: 2.3-9.4 and past exposure to indinavir (PR =1.7; 95% CI: 1.0-2.8. As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare.

  3. Association of glomerular filtration rate with high-sensitivity cardiac troponin T in a community-based population study in Beijing.

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    Fan Wang

    Full Text Available BACKGROUND: Reduced renal function is an independent risk factor for cardiovascular disease mortality, and persistently elevated cardiac troponin T (cTnT is frequently observed in patients with end-stage renal disease. In the general population the relationship between renal function and cTnT levels may not be clear because of the low sensitivity of the assay. In this study, we investigated the level of cTnT using a highly sensitive assay (hs-cTnT and evaluated the association of estimated glomerular filtration rate (eGFR with detectable hs-cTnT levels in a community-based population. METHODS: The serum hs-cTnT levels were measured in 1365 community dwelling population aged ≥45 years in Beijing, China. eGFR was determined by the Chinese modifying modification of diet in renal disease (C-MDRD equation. RESULTS: With the highly sensitive assay, cTnT levels were detectable (≥3pg/mL in 744 subjects (54.5%. The result showed that eGFR was associated with Log hs-cTnT (r = -0.14, P20% and other prognostic indicators, moderate to severe reduced eGFR was independently associated with detectable hs-cTnT, whereas normal to mildly reduced eGFR was not independently associated with detectable hs-cTnT. In addition, after adjustment for other risk factors, the high predicted Framingham CHD risk was associated with detectable hs-cTnT in the subjects with different quartile levels of eGFR. CONCLUSION: The levels of hs-cTnT are detectable in a community-based Chinese population and low eGFR is associated with detectable hs-cTnT. Moreover, eGFR and high predicted Framingham CHD risk are associated with detectable hs-cTnT in subjects with moderate-to-severe reduced renal function.

  4. Sex steroids do not affect shigatoxin cytotoxicity on human renal tubular or glomerular cells

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    Kohan Donald E

    2002-08-01

    Full Text Available Abstract Background The greater susceptibility of children to renal injury in post-diarrheal hemolytic-uremic syndrome (HUS may be related, at least in part, to heightened renal cell sensitivity to the cytotoxic effect of Shiga toxin (Stx, the putative mediator of kidney damage in HUS. We hypothesized that sexual maturation, which coincides with a falling incidence of HUS, may induce a relatively Stx-resistant state in the renal cells. Methods Cultured human glomerular endothelial (HGEN, human glomerular visceral epithelial (HGEC and human proximal tubule (HPT cells were exposed to Stx-1 after pre-incubation with progesterone, β-estradiol or testosterone followed by determination of cytotoxicity. Results Under basal conditions, Stx-1 potently and dose-dependently killed HPT and HGEC, but had relatively little effect on HGEN. Pre-incubation for 1, 2 or 7 days with physiologic or pharmacologic concentrations of progesterone, β-estradiol or testosterone had no effect on Stx-1 cytotoxicity dose-response on any cell type. In addition, no steroid altered Gb3 expression (Stx receptor by any cell type at any time point. Conclusion These data do not support the notion that hormonal changes associated with puberty induce an Stx-resistant state within kidney cells.

  5. Two-year follow-up of patients with septic shock presenting with low HDL: the effect upon acute kidney injury, death and estimated glomerular filtration rate.

    Science.gov (United States)

    Roveran Genga, K; Lo, C; Cirstea, M; Zhou, G; Walley, K R; Russell, J A; Levin, A; Boyd, J H

    2017-05-01

    Sepsis is associated with decreased levels of high-density lipoprotein (HDL) cholesterol. HDL has anti-inflammatory properties, and the use of Apo A-I mimetic peptides is associated with renal function improvement in animal models of sepsis. However, it is not known whether decreased HDL level results in impaired renal function in human sepsis. We investigated whether low levels of HDL conferred an increased risk of sepsis-associated acute kidney injury (AKI) or long-term decreased estimated glomerular filtration rate (eGFR) after sepsis. HDL concentration (mg dL(-1) ) was measured in plasma samples from 180 patients with septic shock at admission to the Emergency Department (ED). We divided the patients using median HDL as a cut-off value and assessed the frequency of sepsis-associated AKI and long-term decreased eGFR after sepsis. Univariate and multivariate analyses were performed. Patients with low HDL had a significantly greater frequency of KDIGO 2 or 3 sepsis-associated AKI [39/90 (43.3%) vs. 12/90 (13.3%), P HDL. The adjusted OR for sepsis-associated AKI and decreased eGFR after sepsis in the lower HDL group was 2.80 (95% CI 1.08-7.25, P = 0.033) and 5.45 (95% CI 1.57-18.93, P = 0.008), respectively. Low HDL levels during sepsis are associated with increased risk of sepsis-associated AKI, and/or subsequent decreased eGFR. These results suggest that HDL may be involved and/or may be a marker of kidney injury during and after sepsis. © 2017 The Association for the Publication of the Journal of Internal Medicine.

  6. The importance of AIF ROI selection in DCE-MRI renography: Reproducibility and variability of renal perfusion and filtration

    Energy Technology Data Exchange (ETDEWEB)

    Cutajar, M., E-mail: m.cutajar@ich.ucl.ac.u [Radiology and Physics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH (United Kingdom); Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX (United Kingdom); Mendichovszky, I.A. [Imaging Science and Biomedical Engineering, University of Manchester, Manchester M13 9PT (United Kingdom); Tofts, P.S. [Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX (United Kingdom); UCL Institute of Neurology, Queen Square, London WC1N 3BG (United Kingdom); Gordon, I. [Radiology and Physics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH (United Kingdom)

    2010-06-15

    Purpose: The aim of this study was to investigate (a) the effect the choice of the region of interest (ROI) defining the aortic input function (AIF) has on the estimation of renal perfusion and filtration in dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) renography, and (b) the reproducibility of these parameters. Using renal DCE-MRI and a three-compartment model analysis, this work evaluated the effect two different AIFs, derived from variable sized ROIs in the aorta, has on calculating DCE-MRI renal perfusion and filtration values in a group of healthy adult volunteers who underwent two consecutive renal DCE-MRI studies. Methods: Fifteen healthy volunteers underwent two DCE-MRI studies under similar physiological conditions. Oblique-coronal DCE-MRI data volumes were acquired on a 1.5 T Siemens Avanto scanner with a 3D-FLASH pulse-sequence (TE/TR = 0.53/1.63 ms, flip angle = 17{sup o}, acquisition matrix = 128 x 104 voxels, strong fat saturation, PAT factor = 2 (GRAPPA) and 400 mm x 325 mm FOV). Each dynamic dataset consisted of 18 slices of 7.5 mm thickness (no gap) and an in-plane resolution of 3.1 mm x 3.1 mm, acquired every 2.5 s for not less than 5 minutes. During the MR scan a dose of 0.05 mmol (0.1 mL) kg{sup -1} body weight of dimeglumine gadopentetate (Magnevist) was injected intravenously (2 mL s{sup -1} injection rate), followed by a 15 mL saline flush at the same rate, using a MR-compatible automated injector (Spectris). Two AIFs were defined for each volunteer by drawing two ROIs in the aorta for each study. Renal perfusion and glomerular filtration rate (GFR) values were then calculated for each of the AIFs using a modified Tofts Renal Model (TRM). Both renal perfusion and GFR were expressed in mL min{sup -1} 100 mL{sup -1} of tissue. Results and conclusion: Inter-individual reproducibility tests for renal perfusion and glomerular filtration rate showed that the size of AIF ROIs significantly affects calculated values of perfusion

  7. Glomerular filtration rate (GFR) and estimation of the GFR (eGFR) in ...

    African Journals Online (AJOL)

    The GFR is the best overall measure of renal function. Jocelyn Naicker, BSc ... in both health and disease.1 Measurement of the GFR is based ... Plasma clearance markers may be endogenous .... ethnicity factor was removed.10 In the eGFR.

  8. Utility of radioisotopic filtration markers in chronic renal insufficiency: Simultaneous comparison of sup 125 I-iothalamate, sup 169 Yb-DTPA, sup 99m Tc-DTPA, and inulin. The Modification of Diet in Renal Disease Study

    Energy Technology Data Exchange (ETDEWEB)

    Perrone, R.D.; Steinman, T.I.; Beck, G.J.; Skibinski, C.I.; Royal, H.D.; Lawlor, M.; Hunsicker, L.G. (National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, MD (USA))

    1990-09-01

    Assessment of glomerular filtration rate (GFR) with inulin is cumbersome and time-consuming. Radioisotopic filtration markers have been studied as filtration markers because they can be used without continuous intravenous (IV) infusion and because analysis is relatively simple. Although the clearances of 99mTc-DTPA, 169Yb-DTPA, and 125I-iothalamate have each been compared with inulin, rarely has the comparability of radioisotopic filtration markers been directly evaluated in the same subject. To this purpose, we determined the renal clearance of inulin administered by continuous infusion and the above radioisotopic filtration markers administered as bolus injections, simultaneously in four subjects with normal renal function and 16 subjects with renal insufficiency. Subjects were studied twice in order to assess within-study and between-study variability. Unlabeled iothalamate was infused during the second half of each study to assess its effect on clearances. We found that renal clearance of 125I-iothalamate and 169Yb-DTPA significantly exceeded clearance of inulin in patients with renal insufficiency, but only by several mL.min-1.1.73m-2. Overestimation of inulin clearance by radioisotopic filtration markers was found in all normal subjects. No differences between markers were found in the coefficient of variation of clearances either between periods on a given study day (within-day variability) or between the two study days (between-day variability). The true test variability between days did not correlate with within-test variability. We conclude that the renal clearance of 99mTc-DTPA, 169Yb-DTPA, or 125I-iothalamate administered as a single IV or subcutaneous injection can be used to accurately measure GFR in subjects with renal insufficiency; use of the single injection technique may overestimate GFR in normal subjects.

  9. The Macrophage Is a Key Factor in Renal Injuries Caused by Glomerular Hyperfiltration

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    Sasaki,Motofumi

    2011-04-01

    Full Text Available Glomerular hyperfiltration is a common pathway leading to glomerulosclerosis in various kinds of kidney diseases. The 5/6 renal ablation is an established experimental animal model for glomerular hyperfiltration. On the other hand, low-grade inflammation is also a common mechanism for the progression of kidney diseases including diabetic nephropathy and atherosclerosis. Here we analyzed the gene expression profile in the remnant kidney tissues of 5/6 nephrectomized mice using a DNA microarray system and compared it with that of sham-operated control mice. The 5/6 nephrectomized mice showed glomerular hypertrophy and an increase in the extracellular matrix in the glomeruli. DNA microarray analysis indicated the up-regulated expression of various kinds of genes related to the inflammatory process in remnant kidneys. We confirmed the up-regulated expression of platelet factor-4, and monocyte chemoattractant protein-1, 2, and 5 in remnant kidneys by RT-PCR. The current results suggest that the inflammatory process is involved in the progression of glomerulosclerosis and is a common pathway of the pathogenesis of kidney disease.

  10. Mycophenolate mofetil prevents high-fat diet-induced hypertension and renal glomerular injury in Dahl SS rats.

    Science.gov (United States)

    Spradley, Frank T; De Miguel, Carmen; Hobbs, Janet; Pollock, David M; Pollock, Jennifer S

    2013-11-01

    We designed experiments to test the hypothesis that Dahl salt-sensitive (SS) rats are sensitive to high-fat diet (HFD)-induced hypertension and renal injury via an inflammatory mechanism. Twelve-week-old Dahl SS rats were maintained on a normal diet (ND; 14% fat), HFD (59% fat), or HFD supplemented with the lymphocyte immunosuppressive agent, mycophenolate mofetil (HFD + MMF; 30 mg/kg/day orally in diet), for a period of 4 weeks. Mean arterial pressure (MAP), metabolic parameters, T lymphocyte (CD3(+)) localization, and renal structural damage were assessed during the studies. Four weeks of HFD significantly elevated MAP and visceral adiposity without changing circulating levels of lipids or adipokines. Immunohistochemical analysis demonstrated that SS rats on HFD had significantly greater numbers of CD3(+) cells in renal glomerular and medullary areas compared to ND SS rats. Additionally, HFD led to increased glomerular injury, but did not alter renal medullary injury. Chronic MMF treatment in HFD-fed Dahl SS rats reduced MAP, visceral adiposity, infiltration of CD3(+) cells in the glomerulus, as well as glomerular injury. However, MMF treatment did not alter HFD-induced infiltration of CD3(+) cells in the renal medulla. In conclusion, Dahl SS rats are sensitized to HFD-induced hypertension and renal glomerular injury via infiltration of T lymphocytes.

  11. Urinary CYP eicosanoid excretion correlates with glomerular filtration in African-Americans with chronic kidney disease.

    Science.gov (United States)

    Dreisbach, Albert W; Smith, Stanley V; Kyle, Patrick B; Ramaiah, Manjunath; Amenuke, Margaret; Garrett, Michael R; Lirette, Seth T; Griswold, Michael E; Roman, Richard J

    2014-10-01

    Previous studies have indicated that cytochrome P450 (CYP) metabolites of arachidonic acid (AA), i.e., 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acids (EETs), play an important role in the regulation of renal tubular and vascular function. The present study for the first time profiled HETEs and epoxygenase derived dihydroxyeicosatetraenoic acid diHETEs levels in spot urines and plasma in 262 African American patients from the University of Mississippi Chronic Kidney Disease Clinic and 31 African American controls. Significant correlations in eGFR and urinary 20-HETE/creatinine and 19-HETE/creatinine levels were observed. The eGFR increased by 17.47 [p=0.001] and 60.68 [(p=0.005]ml/min/for each ng/mg increase in 20-HETE and 19-HETE levels, respectively. Similar significant positive associations were found between the other urinary eicosanoids and eGFR and also with 19-HETE/urine creatinine concentration and proteinuria. We found that approximately 80% of plasma HETEs and 30% diHETEs were glucuronidated and the fractional excretion of 20-HETE was less than 1%. These results suggest that there is a significant hepatic source of urinary 20-HETE glucuronide and EETs with extensive renal biotransformation to metabolites which may play a role in the pathogenesis of CKD.

  12. Urinary CYP Eicosanoid Excretion Correlates with Glomerular Filtration in African-Americans with Chronic Kidney Disease

    Science.gov (United States)

    Dreisbach, Albert W; Smith, Stanley V; Kyle, Patrick B; Ramaiah, Manjunath; Amenuke, Margaret; Garrett, Michael R; Lirette, Seth T; Griswold, Michael E; Roman, Richard J

    2015-01-01

    Previous studies have indicated that cytochrome P450 (CYP) metabolites of arachidonic acid (AA), i.e., 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acids (EETs), play an important role in the regulation of renal tubular and vascular function. The present study for the first time profiled HETEs and epoxygenase derived dihydroxyeicosatetraenoic acid diHETEs levels in spot urines and plasma in 262 African American patients from the University of Mississippi Chronic Kidney Disease Clinic and 31 African American controls. Significant correlations in eGFR and urinary 20-HETE/creatinine and 19-HETE/ creatinine levels were observed. The eGFR increased by 17.47 [p=0.001] and 60.68 [(p=0.005] ml/min/ for each ng/mg increase in 20-HETE and 19-HETE levels, respectively. Similar significant positive associations were found between the other urinary eicosanoids and eGFR and also with 19-HETE/urine creatinine concentration and proteinuria. We found that approximately 80% of plasma HETEs and 30% diHETEs were glucuronidated and the fractional excretion of 20-HETE was less than 1%. These results suggest that there is a significant hepatic source of urinary 20-HETE glucuronide and EETs with extensive renal biotransformation to metabolites which may play a role in the pathogenesis of CKD. PMID:25151892

  13. Glomerular diseases in a Hispanic population: review of a regional renal biopsy database

    Directory of Open Access Journals (Sweden)

    Luis Fernando Arias

    Full Text Available CONTEXT AND OBJECTIVE: Epidemiological data provide useful information for clinical practice and investigations. This study aimed to determine glomerular disease frequencies in a region of Colombia and it represents the basis for future studies. DESIGN AND SETTING: Single-center retrospective analysis at the University of Antioquia, Colombia. METHODS: All native renal biopsies (July 1998 to December 2007 were reviewed, but only glomerular diseases were analyzed. The diagnosis of each case was based on histological, immunopathological and clinical features. RESULTS: A total of 1,040 biopsies were included. In 302 cases (29.0%, the patient's age was < 15 years. Primary glomerular diseases were diagnosed in 828 biopsies (79.6% and secondary in 212 (20.4%. The most common primary diseases were focal and segmental glomerulosclerosis (FSGS (34.8%, immunoglobulin A (IgA nephropathy (IgAN (11.8%, membranous glomerulonephritis (MGN (10.6%, minimal change disease (MCD (10.6%, crescentic glomerulonephritis (GN (5.6%, and non-IgA mesangial proliferative GN (5.6%. Postinfectious GN represented 10.7% of the diagnoses if included as primary GN. Lupus nephritis corresponded to 17.8% of the entire series. In adults, the order of the most frequent primary diseases was: FSGS, IgAN, MGN, crescentic GN and MCD. In children (< 15 years, the most frequent were: FSGS, postinfectious GN, MCD, non-IgA mesangial proliferative GN, endocapillary diffuse GN and IgAN. CONCLUSIONS: As among Afro-Americans, FSGS is the most frequent type of glomerulopathy in our population, but in our group, there are more cases of IgAN. The reasons for these findings are unclear. This information is an important contribution towards understanding the prevalence of renal diseases in Latin America.

  14. Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica Glomerular filtration and associated factors in hypertensive individuals treated at primary care level

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    Ana Karina Teixeira da Cunha França

    2010-06-01

    Full Text Available FUNDAMENTO: No Brasil, a hipertensão arterial (HA constitui-se um dos principais fatores de risco para doença renal crônica (DRC. Recomenda-se o monitoramento da filtração glomerular (FG para avaliação da função renal em hipertensos, posto que sua redução precede o aparecimento de sintomas. OBJETIVO: Avaliar a FG e fatores associados em hipertensos. MÉTODOS: Realizou-se estudo transversal no período de janeiro a junho de 2008, com 297 hipertensos com ou sem diabete melito (DM tratados em uma unidade básica de saúde em São Luís-MA. Foram incluídos pacientes >20 anos e de ambos os sexos. Avaliaram-se dados sociodemográficos, estado nutricional, FG e microalbuminúria em urina de 24h, controle pressórico e glicêmico, creatinina sérica e lipidograma. RESULTADOS: A idade média foi 60,6 × 11,5 anos com predomínio do sexo feminino (75,1%, sobrepeso/obesidade (65,0% e circunferência da cintura elevada (60,6%. A prevalência de FG 65 anos, que permaneceu após ajustamento. Para o grupo HA com DM houve associação da redução da FG com idade > 65 anos, tabagismo e obesidade, porém, após ajustamento, permaneceram idade e tabagismo. CONCLUSÃO: Nestes pacientes, a prevalência de FG 65 anos e tabagismo apresentaram-se como fatores associados à FG. Isto reforça a necessidade da avaliação sistemática da FG em hipertensos visando a prevenção secundária da doença renal crônica.BACKGROUND: In Brazil, arterial hypertension (AH constitutes one of the main risk factors for chronic kidney disease (CKD. The monitoring of glomerular filtration (GF is recommended for the assessment of kidney function in hypertensive individuals, as GF decrease precedes symptom onset. OBJECTIVE: To assess GF and its associated factors in hypertensive individuals. METHODS: A cross-sectional study was carried out from January to June 2008 in 297 individuals with arterial hypertension (AH with or without diabetes mellitus (DM, treated at a primary

  15. Depression and Quality of Life in Relation to Decreased Glomerular Filtration Rate Among Adults with Hypertension in Rural Northeast China

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    Xiaofan Guo

    2015-02-01

    Full Text Available Background/Aims: We aim to investigate the extent to which depression and quality of life might be associated with decreased glomerular filtration rate (GFR in a large hypertensive population in rural Northeast China. Methods: A total of 5566 hypertensive participants aged 35 years and older were screened with a stratified cluster multistage sampling scheme in rural areas of Liaoning Province during 2012-2013. Decreased GFR was defined as estimated GFR 2. Results: The overall prevalence of decreased GFR was 3.2%. In the multivariable regression model, participants with moderate or greater depression had a greater risk for having a decreased GFR (OR: 1.739, 95%CI: 1.004 to 3.014 after full adjustment. Every 1-point increase of all the domains in WHOQOL-BREF, except for physical and environment domains, was significantly related to a lower risk for decreased GFR adjusting for age, gender and race. However, after fully adjustment, only social relations remained significant (OR: 0.899, 95%CI: 0.820 to 0.985. Increasing in total scores of WHOQOL-BREF was a protective factor against decreased GFR after fully adjustment. Conclusion: We found that moderate or greater depression and lower quality of life were associated with higher risks for developing decreased GFR.

  16. Association between the delta estimated glomerular filtration rate and the prevalence of monoclonal gammopathy of undetermined significance in Korean males.

    Science.gov (United States)

    Jeong, Tae-Dong; Lee, Woochang; Chun, Sail; Min, Won-Ki

    2014-01-01

    We investigated the association between the reduction in the estimated glomerular filtration rate (eGFR) and the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in Korean males. We enrolled 723 healthy Korean males. Serum creatinine concentration, serum electrophoresis, serum immunofixation, and the serum free light chain assay were performed. We calculated delta eGFR per year (ΔeGFR/yr). The prevalence of MGUS was compared based on the ΔeGFR/yr and age group. Thirteen (1.8%) of 723 participants exhibited the monoclonal band on serum immunofixation. Prevalence of MGUS by age group was 0.00% (0/172 for 40 years), 1.63% (6/367 for 60 years), and 3.80% (7/184 for >60 years). The median decrease in ΔeGFR/yr was 5.3%. The prevalence of MGUS in participants in their 50s with >5.3% decline in ΔeGFR/yr was significantly higher than those with 5.3% decrease in ΔeGFR/yr was similar to that of healthy males in their 60s. Using the rate of reduction in ΔeGFR/yr in healthy Korean males who had their serum creatinine level checked regularly may increase the MGUS detection rate in clinical practice.

  17. A Comprehensive Software and Database Management System for Glomerular Filtration Rate Estimation by Radionuclide Plasma Sampling and Serum Creatinine Methods.

    Science.gov (United States)

    Jha, Ashish Kumar

    2015-01-01

    Glomerular filtration rate (GFR) estimation by plasma sampling method is considered as the gold standard. However, this method is not widely used because the complex technique and cumbersome calculations coupled with the lack of availability of user-friendly software. The routinely used Serum Creatinine method (SrCrM) of GFR estimation also requires the use of online calculators which cannot be used without internet access. We have developed user-friendly software "GFR estimation software" which gives the options to estimate GFR by plasma sampling method as well as SrCrM. We have used Microsoft Windows(®) as operating system and Visual Basic 6.0 as the front end and Microsoft Access(®) as database tool to develop this software. We have used Russell's formula for GFR calculation by plasma sampling method. GFR calculations using serum creatinine have been done using MIRD, Cockcroft-Gault method, Schwartz method, and Counahan-Barratt methods. The developed software is performing mathematical calculations correctly and is user-friendly. This software also enables storage and easy retrieval of the raw data, patient's information and calculated GFR for further processing and comparison. This is user-friendly software to calculate the GFR by various plasma sampling method and blood parameter. This software is also a good system for storing the raw and processed data for future analysis.

  18. Is the Chronic Kidney Disease Epidemiology Collaboration creatinine–cystatin C equation useful for glomerular filtration rate estimation in the elderly?

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    Liu X

    2013-10-01

    Full Text Available Xun Liu,1,2,* Huijuan Ma,1,* Hui Huang,3 Cheng Wang,1 Hua Tang,1 Ming Li,1 Yanni Wang,1 Tanqi Lou1 1Division of Nephrology, Department of Internal Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 2College of Biology Engineering, South China University of Technology, 3Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China*These authors contributed equally to the paperBackground: We aimed to evaluate the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI creatinine–cystatin C equation in a cohort of elderly Chinese participants.Materials and methods: Glomerular filtration rate (GFR was measured in 431 elderly Chinese participants by the technetium-99m diethylene-triamine-penta-acetic acid (99mTc-DTPA renal dynamic imaging method, and was calibrated equally to the dual plasma sample 99mTc-DTPA-GFR. Performance of the CKD-EPI creatinine–cystatin C equation was compared with the Cockroft–Gault equation, the re-expressed 4-variable Modification of Diet in Renal Disease (MDRD equation, and the CKD-EPI creatinine equation.Results: Although the bias of the CKD-EPI creatinine–cystatin C equation was greater than with the other equations (median difference, 5.7 mL/minute/1.73 m2 versus a range from 0.4–2.5 mL/minute/1.73 m2; P<0.001 for all, the precision was improved with the CKD-EPI creatinine–cystatin C equation (interquartile range for the difference, 19.5 mL/minute/1.73 m2 versus a range from 23.0–23.6 mL/minute/1.73 m2; P<0.001 for all comparisons, leading to slight improvement in accuracy (median absolute difference, 10.5 mL/minute/1.73 m2 versus 12.2 and 11.4 mL/minute/1.73 m2 for the Cockcroft–Gault equation and the re-expressed 4-variable MDRD equation, P=0.04 for both; 11.6 mL/minute/1.73 m2 for the CKD-EPI creatinine equation, P=0.11, as the optimal scores of performance (6.0 versus a range from 1.0–2.0 for the other

  19. The Application of Digital Pathology to Improve Accuracy in Glomerular Enumeration in Renal Biopsies.

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    Avi Z Rosenberg

    Full Text Available In renal biopsy reporting, quantitative measurements, such as glomerular number and percentage of globally sclerotic glomeruli, is central to diagnostic accuracy and prognosis. The aim of this study is to determine the number of glomeruli and percent globally sclerotic in renal biopsies by means of registration of serial tissue sections and manual enumeration, compared to the numbers in pathology reports from routine light microscopic assessment.We reviewed 277 biopsies from the Nephrotic Syndrome Study Network (NEPTUNE digital pathology repository, enumerating 9,379 glomeruli by means of whole slide imaging. Glomerular number and the percentage of globally sclerotic glomeruli are values routinely recorded in the official renal biopsy pathology report from the 25 participating centers. Two general trends in reporting were noted: total number per biopsy or average number per level/section. Both of these approaches were assessed for their accuracy in comparison to the analogous numbers of annotated glomeruli on WSI.The number of glomeruli annotated was consistently higher than those reported (p<0.001; this difference was proportional to the number of glomeruli. In contrast, percent globally sclerotic were similar when calculated on total glomeruli, but greater in FSGS when calculated on average number of glomeruli (p<0.01. The difference in percent globally sclerotic between annotated and those recorded in pathology reports was significant when global sclerosis is greater than 40%.Although glass slides were not available for direct comparison to whole slide image annotation, this study indicates that routine manual light microscopy assessment of number of glomeruli is inaccurate, and the magnitude of this error is proportional to the total number of glomeruli.

  20. Correlation of the glomerular filtration rate by the Gates scintigraphy method and by the creatinine purification in urine of 24 hours; Correlacion de la tasa de filtracion glomerular por el metodo gamagrafico de Gates y por la depuracion de creatinina en orina de 24 horas

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    Gomez A, E

    2003-07-01

    The kidney is an important organ that makes that exist equilibrium inside the organism. In it' s multiple functions, one that interests us to know is the glomerular filtration rate (GFR). To know this, exist laboratory and scintigraphy studies like the scintigraphy with technique of Gates and the creatinine purification in urine of 24 hours. The files of 44 patients were studied, which were clinically candidates to kidney donors healthy (25 women and 19 men) with ages that varied from the 18 years to the 54 years ( 35.1 years), with a weight of 43 kilograms to 94 kilograms (68.95 Kg) and with a corporal surface of 1.29 to 2.08 m{sup 2} (1.70 m{sup 2}). These patients underwent study protocols with creatinine purification and with renal scintigraphy. The glomerular filtration rate obtained by creatinine purification varied from 51.9 ml/min. to 156 ml/min. and the GFR obtained by scintigraphy varied from 3.6 ml/min. to 155.2 ml/min. Once obtained the gathering of data the test of Student was applied to compare the averages of both distributions and the analysis of lineal regression to determine the coefficients of correlation of the complete group. (Author)

  1. Proteomic analysis of formalin-fixed paraffin-embedded glomeruli suggests depletion of glomerular filtration barrier proteins in two-kidney, one-clip hypertensive rats.

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    Finne, Kenneth; Vethe, Heidrun; Skogstrand, Trude; Leh, Sabine; Dahl, Tone D; Tenstad, Olav; Berven, Frode S; Reed, Rolf K; Vikse, Bjørn Egil

    2014-12-01

    It is well known that hypertension may cause glomerular damage, but the molecular mechanisms involved are still incompletely understood. In the present study, we used formalin-fixed paraffin-embedded (FFPE) tissue to investigate changes in the glomerular proteome in the non-clipped kidney of two-kidney one-clip (2K1C) hypertensive rats, with special emphasis on the glomerular filtration barrier. 2K1C hypertension was induced in 6-week-old Wistar Hannover rats (n = 6) that were sacrificed 23 weeks later and compared with age-matched sham-operated controls (n = 6). Tissue was stored in FFPE tissue blocks and later prepared on tissue slides for laser microdissection. Glomeruli without severe morphological damage were isolated, and the proteomes were analysed using liquid chromatography-tandem mass spectrometry. 2K1C glomeruli showed reduced abundance of proteins important for slit diaphragm complex, such as nephrin, podocin and neph1. The podocyte foot process had a pattern of reduced abundance of transmembrane proteins but unchanged abundances of the podocyte cytoskeletal proteins synaptopodin and α-actinin-4. Lower abundance of important glomerular basement membrane proteins was seen. Possible glomerular markers of damage with increased abundance in 2K1C were transgelin, desmin and acyl-coenzyme A thioesterase 1. Microdissection and tandem mass spectrometry could be used to investigate the proteome of isolated glomeruli from FFPE tissue. Glomerular filtration barrier proteins had reduced abundance in the non-clipped kidney of 2K1C hypertensive rats. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA.

  2. The relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

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    Esen, Bennur; Atay, Ahmet Engin; Gokmen, Emel Saglam; Karakoc, Ayten; Sari, Hakan; Sarisakal, Samprie; Kahvecioglu, Serdar; Kayabasi, Hasan; Sit, Dede

    2015-05-08

    Complementary and alternative medicine is a broad field of health including all health care practices and methods; and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage. A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding to complementary-alternative medicine use were performed. The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (p:0.007, p:0.016, p:0.02, p:0.016; respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (p:0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (p:0.002; r: 0,093). We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods. This article is protected by copyright. All rights reserved.

  3. Urinary neutrophil gelatinase-associated lipocalin and cystatin C compared to the estimated glomerular filtration rate to predict risk in patients with suspected acute myocardial infarction.

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    von Jeinsen, Beatrice; Kraus, Daniel; Palapies, Lars; Tzikas, Stergios; Zeller, Tanja; Schauer, Anne; Drechsler, Christiane; Bickel, Christoph; Baldus, Stephan; Lackner, Karl J; Münzel, Thomas; Blankenberg, Stefan; Zeiher, Andreas M; Keller, Till

    2017-10-15

    Impaired renal function, reflected by estimated glomerular filtration rate (eGFR) or cystatin C, is a strong risk predictor in the presence of acute myocardial infarction (AMI). Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of acute kidney injury. uNGAL might also be a good predictor of outcome in patients with cardiovascular disease. Aim of the present study was to evaluate the prognostic value of uNGAL compared to eGFR and cystatin C in patients with suspected AMI. 1818 patients were enrolled with suspected AMI. Follow-up information on the combined endpoint of death or non-fatal myocardial infarction was obtained 6months after enrolment and was available in 1804 patients. 63 events (3.5%) were registered. While cystatin C and eGFR were strong risk predictors for the primary endpoint even adjusted for several variables, uNGAL was not independently associated with outcome: When applied continuously uNGAL was associated with outcome but did not remain a statistically significant predictor after several adjustments (i.e. eGFR). By adding cystatin C or uNGAL to GRACE risk score variables, only cystatin C could improve the predictive value while uNGAL showed no improvement. We could show that cystatin C is an independent risk predictor in patients with suspected AMI and cystatin C can add improvement to the commonly used GRACE risk score. In contrast uNGAL is not independently associated with outcome and seems not to add further prognostic information to GRACE risk score. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations

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    Ji, Misuk; Lee, Yoon-Hee; Kim, Hyesun; Cho, Han-Ik; Yang, Hyun Suk; Navarin, Silvia; Di Somma, Salvatore

    2016-01-01

    Background Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. Methods The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m2. Results For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m2) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPICysC and -20.5 for CKD-EPICr-CysC). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPICysC). Conclusions Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings. PMID:27578504

  5. Long-Term Follow-Up of Proteinuria and Estimated Glomerular Filtration Rate in HIV-Infected Patients with Tubular Proteinuria.

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    Peyriere, Hélène; Cournil, Amandine; Casanova, Marie-Laure; Badiou, Stéphanie; Cristol, Jean-Paul; Reynes, Jacques

    2015-01-01

    The objective of this prospective observational study was to describe the evolution of tubular proteinuria detected in HIV-infected patients, and to evaluate the impact of tenofovir disoproxil fumarate (TDF) discontinuation. Proteinuria and estimated glomerular filtration rate (eGFR) were followed during a median duration of 32 months, in 81 HIV-infected patients with tubular proteinuria and eGFR ≥ 60 ml/min/1.73 m2 (determined using the Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation). Tubular proteinuria was defined by urine protein to creatinine ratio (uPCR) ≥200 mg/g and albumin to protein ratio (uAPR) proteinuria: TDF continuation was the main factor associated with this persistence [OR 9.0; 95%CI: 1.9-41.4; p = 0.01]. Among the 23 patients who discontinued TDF, uPCR returned below the threshold of 200 mg/g in 11 patients. Overall, eGFR decreased with a mean rate of decline of 3.8 ml/min/1.73m2/year. The decline in eGFR was lesser after discontinuation of TDF (5.8 ml/min/1.73m2/year during TDF exposure versus 3 ml/min/1.73m2/year after TDF discontinuation; p = 0.01). The continuation of TDF was the main factor associated with the persistence of proteinuria. Moreover, proteinuria was normalized in only half of the patients who discontinued TDF. The clinical significance of TDF-related low level of proteinuria as a factor associated with renal disease progression and bone loss remains poorly understood.

  6. Triglyceride levels are closely associated with mild declines in estimated glomerular filtration rates in middle-aged and elderly Chinese with normal serum lipid levels.

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    Xinguo Hou

    Full Text Available OBJECTIVE: To investigate the relationship between lipid profiles [including total cholesterol (TC, triglyceride (TG, low-density lipoprotein cholesterol (LDL-C and high-density lipoprotein cholesterol (HDL-C] and a mild decline in the estimated glomerular filtration rate (eGFR in subjects with normal serum lipid levels. DESIGN AND METHODS: In this study, we included 2647 participants who were ≥ 40 years old and had normal serum lipid levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equation was used to estimate the GFR. A mildly reduced eGFR was defined as 60-90 mL/min/1.73 m(2. First, multiple linear regression analysis was used to estimate the association of lipid profiles with the eGFR. Then, the levels of each lipid component were divided into four groups, using the 25th, 50th and 75th percentiles as cut-off points. Finally, multiple logistic regression analysis was used to investigate the association of different lipid components with the risk of mildly reduced eGFR. RESULTS: In the group with a mildly reduced eGFR, TG and LDL-C levels were significantly increased, but HDL-C levels were significantly decreased. After adjusting for age, gender, body mass index (BMI, systolic blood pressure (SBP, glycated hemoglobin (HbA1c, smoking and drinking, only TC and TG were independently related to the eGFR. Additionally, only TG showed a linear relationship with an increased risk of a mildly reduced eGFR, with the highest quartile group (TG: 108-150 mg/dl [1.22-1.70 mmol/L] having a significantly increased risk after adjusting for the above factors. CONCLUSIONS: Triglyceride levels are closely associated with a mildly reduced eGFR in subjects with normal serum lipid levels. Dyslipidemia with lower TG levels could be used as new diagnostic criteria for subjects with mildly reduced renal function.

  7. Creatinine clearance, urinary excretion of glomerular basement membrane antigens and renal histology in congenital nephrotic syndrome of Finnish type.

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    Huttunen, N P

    1977-04-01

    The endogenous creatinine clearance and urinary excretion rate of glomerular basement membrane (GBM) antigens were followed from 2 to 19 months in fifteen patients with congenital nephrotic syndrome (CNF). The quantitative examination of renal morphology was made on fourteen of these patients. Creatinine clearance increased during the first few months of life and thereafter gradually decreased. The urinary excretion rate of GBM antigens rose during the course of the disease. The creatinine clearance did not correlate significantly with glomerular fibrosis but it did correlate with tubular atrophy and interstitial fibrosis. The urinary excretion of GBM antigens correlated significantly with glomerular and interstitial fibrosis and with tubular atrophy. It is concluded that there is a clear progress in the disease and the renal histological changes probably are caused by accumulation of GBM material in glomeruli.

  8. Ischemia-induced glomerular parietal epithelial cells hyperplasia: Commonly misdiagnosed cellular crescent in renal biopsy.

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    Zeng, Yeting; Wang, Xinrui; Xie, Feilai; Zheng, Zhiyong

    2017-08-01

    Ischemic pseudo-cellular crescent (IPCC) that is induced by ischemia and composed of hyperplastic glomerular parietal epithelial cells resembles cellular crescent. In this study, we aimed to assess the clinical and pathological features of IPCC in renal biopsy to avoid over-diagnosis and to determine the diagnostic basis. 4 IPCC cases diagnosed over a 4-year period (2012-2015) were evaluated for the study. Meanwhile, 5 cases of ANCA-associated glomerulonephritis and 5 cases of lupus nephritis (LN) were selected as control. Appropriate clinical data, morphology, and immunohistochemical features of all cases were retrieved. Results showed that the basement membrane of glomerulus with IPCC appeared as a concentric twisted ball, and glomerular cells of the lesion were reduced even entirely absent, and the adjacent afferent arterioles showed sclerosis or luminal stenosis. Furthermore, immune globulin deposition, vasculitis, and fibrinous exudate have not been observed in IPCC. While the cellular crescents showed diverse characteristics in both morphology and immunostaining in the control group. Therefore, these results indicated that IPCC is a sort of ischemic reactive hyperplasia and associated with sclerosis, stenosis, or obstruction of adjacent afferent arterioles, which is clearly different from cellular crescents result from glomerulonephritis. Copyright © 2017 Elsevier GmbH. All rights reserved.

  9. 慢性肾脏病患者肾小球滤过率与血清Cystatin C相关性分析%Correlation Analysis Between Glomerular Filtration Rate and Serum Cystatin C in Patients with Chronic Kidney Disease

    Institute of Scientific and Technical Information of China (English)

    杨斌

    2011-01-01

    To explore the correlation between glomerular filtration rate (GFR) and serum cystatin C in patients with chronic kidney disease ( CKD). The serum cystatin C levels in 340 patients with CKD and 60 health controls were determined by particles enhance turbidimetric immune analysis. The GFR was calculated by the simplified equation derived from the modification of diet in renal disease study (MDRD). The results showed thatthe CFR was significant negatively correlated with cystatin C and SCr (P <0.01) and cystatin C had a stronger correlations with GFR. There was significant statistical difference between cystatin C and SCr ( P < 0.05 ). The reflect glomerular filtration function of cystatin C was more accurately than that SCr, it may be useful for the early diagnosis of CFR function in the patients with chronic kidney disease.%探讨慢性肾脏病(chronic kidney disease,CKD)患者肾小球滤过率(glomentlar filtration rate,GFR)与血清半胱氨酸蛋白酶抑制剂C(cystatin C)的相关性.采用颗粒增强免疫浊度分析法测定340例CKD组患者和60名对照组血清cystatin C,全自动生化分析仪检测血清SCr,采用校正eMDRD方程计算GFR,比较各指标与GFR间的相关性.结果表明:GFR与cystatin C、SCr间呈明显负相关(P<0.01),且与cystatin C相关最为密切.cystatin C与SCr有显著性差异(P<0.05).血清cystatin C能准确反映CKD患者GFR,对早期诊断CKD患者肾小球滤过功能有价值.

  10. Modified Glomerular Filtration Rate-Estimating Equations Developed in Asiatic Population for Chinese Patients with Type 2 Diabetes

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    Xun Liu

    2014-01-01

    Full Text Available Objectives. To evaluate eight modified equations developed in Asiatic populations in type 2 diabetic patients in China. Methods. A total of 209 Chinese patients with type 2 diabetes were recruited. Using the technetium—99m diethylenetriaminepentaacetic acid—glomerular filtration rate (GFR to act as the reference, comparisons of their efficiency to estimate GFR in the subjects were made between various equations. Results. Median of difference of the Chinese equation 1 was the lowest (median of difference, 0.51 mL/min/1.73 m2. Median percent of absolute difference of the Chinese equation 2 was less than those of the other equations (26.97 versus ranged from 32.54 to 37.61 mL/min/1.73 m2, [P<0.001 for all]. Precision of the simplified reexpressed MDRD equation was the best (92.9 mL/min/1.73 m2. Accuracies of the Chinese equation 2 were greater (P<0.05 for all. There was also an improvement in chronic kidney disease (CKD stage misclassification of the Chinese equation 2 (55.0 versus ranged from 61.2 to 64.6%, [P<0.001 for all]. However, the 30% accuracies of all the equations were less than 70%. Conclusions. Our study highlighted a limitation in the use of the above equations in the majority of Chinese diabetic subjects. A better equation is needed in order to give an accurate estimation of GFR in type 2 diabetic patients in China.

  11. Correlation between Serum Lipid Levels and Measured Glomerular Filtration Rate in Chinese Patients with Chronic Kidney Disease

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    Wang, Caixia; Ye, Zengchun; Li, Shaomin; Liu, Qiong; Lou, Tanqi

    2016-01-01

    Introduction Dyslipidemia is often detected in patients with chronic kidney disease (CKD). Previous studies of the relationship between lipid profiles and kidney function have yielded variable results. We aimed to investigate the correlation between serum lipid levels and kidney function evaluated by measured glomerular filtration rate (mGFR) in Chinese patients with CKD. Methods A cross-sectional study was conducted on 2036 Chinese CKD patients who had mGFR. Linear regression analysis was performed to evaluate the correlation between different serum lipid levels and mGFR, while logistic regression analysis was used to investigate the association between CKD stages and the risk of different types of dyslipidemia. Results The mean age was 55 years and the mean mGFR was 63 mL/min/1.73m2. After adjusting for some confounders (age, gender, body mass index, a history of diabetes, fasting glucose, a history of hypertension, systolic blood pressure, diastolic blood pressure, smoking status, hemoglobin, serum potassium, serum albumin, and serum uric acid), serum triglyceride level showed a negative correlation with mGFR (β = -0.006, P = 0.006) in linear regression analysis, and CKD stages were positively related to the risk of hypertriglyceridemia (odds ratios were 1.329, 1.868, 2.514 and P were 0.046, < 0.001, < 0.001 for CKD stage 2, 3, 4/5, respectively) in logistic regression anlysis. Conclusions Serum triglyceride level is independently association with mGFR. Patients with reduced kidney function are more likely to have higher serum triglyceride levels. Further longitudinal, multicenter and well-conducted studies are needed to provide more evidence. PMID:27695128

  12. Correlation of carotid intimal-medial thickness with estimated glomerular filtration rate and cardiovascular risk factors in chronic kidney disease

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    Nitesh Chhajed

    2014-01-01

    Full Text Available Carotid intimal-medial thickness (CIMT predicts future vascular events in the general population. However, the correlation of traditional cardiovascular risk factors and stages of chronic kidney disease (CKD with CIMT is not studied extensively. To determine the correlation of CIMT with traditional cardiovascular risk factors like age, body mass index (BMI, dyslipidemia and various stages of CKD patients, CIMT was measured by means of high-resolution B-mode ultrasonography in 70 CKD patients and compared with the 30 healthy controls. The mean CIMT in patients was 0.86 ± 0.21 mm vs 0.63 ± 0.17 mm in healthy age- and sex-matched controls (P <0.001. There was a significant univariate positive correlation between CIMT and age (r = 0.605, P <0.001, BMI (r = 0.377, P = 0.001, total cholesterol (r = 0.236, P ≤0.018 and serum triglyceride (r = 0.387, P ≤0.001. No statistically significant correlation was found between mean CIMT and estimated glomerular filtration rate (eGFR (r = -0.02, P = 0.30, very low-density lipoprotein and high-density lipoprotein-cholesterol. Atherosclerotic changes very well correlate with the traditional cardiovascular risk factors like age, BMI, serum total cholesterol and serum triglyceride level in CKD patients. Even though CIMT was marginally more in the late stages of CKD patients, no statistically significant correlation was found with CIMT and eGFR.

  13. Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions

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    Jaar Bernard G

    2011-01-01

    Full Text Available Abstract Background Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. Methods We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR 2 of their recommended referrals based on their use of creatinine versus eGFR. Results Primary care physicians recommended subspecialty referrals later (CKD more advanced when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m2, p Conclusions Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.

  14. A genome-wide search for linkage of estimated glomerular filtration rate (eGFR in the Family Investigation of Nephropathy and Diabetes (FIND.

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    Farook Thameem

    Full Text Available OBJECTIVE: Estimated glomerular filtration rate (eGFR, a measure of kidney function, is heritable, suggesting that genes influence renal function. Genes that influence eGFR have been identified through genome-wide association studies. However, family-based linkage approaches may identify loci that explain a larger proportion of the heritability. This study used genome-wide linkage and association scans to identify quantitative trait loci (QTL that influence eGFR. METHODS: Genome-wide linkage and sparse association scans of eGFR were performed in families ascertained by probands with advanced diabetic nephropathy (DN from the multi-ethnic Family Investigation of Nephropathy and Diabetes (FIND study. This study included 954 African Americans (AA, 781 American Indians (AI, 614 European Americans (EA and 1,611 Mexican Americans (MA. A total of 3,960 FIND participants were genotyped for 6,000 single nucleotide polymorphisms (SNPs using the Illumina Linkage IVb panel. GFR was estimated by the Modification of Diet in Renal Disease (MDRD formula. RESULTS: The non-parametric linkage analysis, accounting for the effects of diabetes duration and BMI, identified the strongest evidence for linkage of eGFR on chromosome 20q11 (log of the odds [LOD] = 3.34; P = 4.4 × 10(-5 in MA and chromosome 15q12 (LOD = 2.84; P = 1.5 × 10(-4 in EA. In all subjects, the strongest linkage signal for eGFR was detected on chromosome 10p12 (P = 5.5 × 10(-4 at 44 cM near marker rs1339048. A subsequent association scan in both ancestry-specific groups and the entire population identified several SNPs significantly associated with eGFR across the genome. CONCLUSION: The present study describes the localization of QTL influencing eGFR on 20q11 in MA, 15q21 in EA and 10p12 in the combined ethnic groups participating in the FIND study. Identification of causal genes/variants influencing eGFR, within these linkage and association loci, will open new avenues for functional analyses

  15. Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: Comparison with 24 h urine creatinine clearance

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    Abdul Rauf Hafeez

    2016-01-01

    Full Text Available To determine the accuracy of estimated glomerular filtration rate (eGFR using the modification of diet in renal disease (MDRD, Cockcroft-Gault (CG, and chronic kidney disease epidemiology (CKD-EPI formulas in potential kidney donors compared with 24-h urine creatinine clearance, we studied 207 potential live kidney donors in our center. There were 126 (60.9% males and 81 (39.1% females. Male:female ratio was 1.6:1. The age of the donors ranged from 18-58 years, with mean age of 35.30 ± 9.23 years and most of the individuals were below 40 years of age. The body mass index (BMI was calculated and venous blood samples were obtained for the measurement of serum creatinine and every study participant was instructed to collect 24-h urine. GFR was calculated based on 24-h urine creatinine clearance and the formulas. The accuracy of GFR estimation formula was taken as positive if the GFR calculated by the formulas and urine creatinine clearance fell between 90-120 mL/min/1.73 m 2 . The accuracy of the MDRD formula was 48.8% and the CG formula was 41.5% whereas the accuracy of the CKD-EPI formula was 78.2%. The accuracy of the eGFR using the MDRD formula was significantly higher in males than females (57.9% vs. 33.3% P = 0.001, while there was no statistically significant difference in the eGFR between them in case of the use of the CG and the CKD-EPI formulas. BMI and obesity had no effect on the accuracy of eGFR by the use of the different formulas. The performance of GFR estimation formulas was sub optimal and these either underestimated and/or over-estimated the GFR in healthy subjects. CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.

  16. Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: Comparison with 24 h urine creatinine clearance.

    Science.gov (United States)

    Hafeez, Abdul Rauf; Idrees, Muhammad Khalid; Akhtar, Syed Fazal

    2016-03-01

    To determine the accuracy of estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD), Cockcroft-Gault (CG), and chronic kidney disease epidemiology (CKD-EPI) formulas in potential kidney donors compared with 24-h urine creatinine clearance, we studied 207 potential live kidney donors in our center. There were 126 (60.9%) males and 81 (39.1%) females. Male:female ratio was 1.6:1. The age of the donors ranged from 18-58 years, with mean age of 35.30 ± 9.23 years and most of the individuals were below 40 years of age. The body mass index (BMI) was calculated and venous blood samples were obtained for the measurement of serum creatinine and every study participant was instructed to collect 24-h urine. GFR was calculated based on 24-h urine creatinine clearance and the formulas. The accuracy of GFR estimation formula was taken as positive if the GFR calculated by the formulas and urine creatinine clearance fell between 90-120 mL/min/1.73 m(2). The accuracy of the MDRD formula was 48.8% and the CG formula was 41.5% whereas the accuracy of the CKD-EPI formula was 78.2%. The accuracy of the eGFR using the MDRD formula was significantly higher in males than females (57.9% vs. 33.3% P = 0.001), while there was no statistically significant difference in the eGFR between them in case of the use of the CG and the CKD-EPI formulas. BMI and obesity had no effect on the accuracy of eGFR by the use of the different formulas. The performance of GFR estimation formulas was sub optimal and these either underestimated and/or over-estimated the GFR in healthy subjects. CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.

  17. Relationship Between Type of Hypertension and Renal Arteriolosclerosis in Chronic Glomerular Disease

    Directory of Open Access Journals (Sweden)

    Keiji Kono

    2016-06-01

    Full Text Available Background/Aims: Hypertension (HT is a common complication in patients with chronic kidney disease (CKD. However, the relationship between circadian rhythm disorder of blood pressure (BP and intra-renal damage remains unclear. Methods: Ninety patients with chronic glomerular disease (CGD were included in the present study. On the basis of the clinic BP (CBP and 24 h-ambulatory BP (ABP measurements, the patients were divided into the following groups; normotension (NT, white coat HT (WHT, masked HT (MHT, and sustained HT (SHT. For renal histopathological assessment, we evaluated each biopsy specimen for sclerotic glomeruli (SG, interstitial fibrosis (IF, intimal thickening of intra-lobular arteries (ILA, and arteriolar hyalinosis (AH. Results: The prevalence of NT, WHT, MHT and SHT was 60.0%, 3.3%, 23.3%, and 13.4%, respectively. Compared with circadian BP pattern, all-day HT was most prevalent in the SHT group, whereas nighttime HT was most prevalent in the MHT group. The results of histological analysis showed that the SHT group had more severe SG and IF and the MHT group had more severe IF compared to the NT group. As for renal arteriolosclerosis, the MHT and SHT groups had more severe AH compared with the NT group, whereas ILA was comparable among all four groups. Furthermore, multivariate analysis revealed that ILA was significantly correlated only with age, whereas AH was significantly correlated with age and HT based on ABP, but not HT based on CBP. Conclusions: Our findings suggest that renal AH was severe not only in the SHT group, but also in the MHT group. Careful ABP monitoring should be recommended in patients with CGD.

  18. Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors pre-nephrectomy and post-nephrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Cutajar, Marica; Clark, Christopher A.; Gordon, Isky [University College London, Imaging and Biophysics Unit, Institute of Child Health, London (United Kingdom); Hilton, Rachel; Olsburgh, Jonathon [Renal Unit, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Marks, Stephen D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Paediatric Nephrology, London (United Kingdom); Thomas, David L. [University College London, Department of Brain Repair and Rehabilitation, Institute of Neurology, London (United Kingdom); Banks, Tina [Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London (United Kingdom)

    2015-08-15

    Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ({sup 51}Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. (orig.)

  19. Differential renal glomerular changes induced by 5/6 nephrectomization between common marmoset monkeys (Callithrix jacchus) and rats.

    Science.gov (United States)

    Suzuki, Yui; Yamaguchi, Itaru; Onoda, Noriko; Saito, Takashi; Myojo, Kensuke; Imaizumi, Minami; Takada, Chie; Kimoto, Naoya; Takaba, Katsumi; Yamate, Jyoji

    2013-07-01

    We have been investigating the relevance and availability of 5/6 nephrectomized (Nx) common marmoset monkeys (Callithrix jacchus) as a chronic renal failure model. As a part of this investigation, renal glomerular changes in the Nx marmosets were histopathologically and immunohistochemically evaluated, and then compared with those in 5/6 Nx SD rats. In the Nx marmosets, the blood and urine parameters were elevated, excluding urine protein; histopathologically, enlargement of Bowman's capsule and atrophy of the glomeruli were observed in all animals, and other slight changes were also observed in 1 or 2 marmosets. There were no significant changes in the mesangial matrix injury score, vimentin and desmin positivity or the number of WT1 positive cells between the control and Nx marmoset groups. On the other hand, in the Nx rats, the blood and urine parameters were elevated; histopathologically, various changes were observed in the glomeruli, and the mesangial matrix injury score, vimentin and desmin positivity were increased, while the number of WT1 positive cells was decreased; these histopathological impacts on the renal glomerulus at 13 weeks after Nx in rats were more severe than that in the Nx marmosets. Because the glomerular basement membrane (GBM) was much thicker in the marmosets than in the rats in electron microscopy, the weaker pathological changes in the Nx marmosets might be due to the GBM thickness. This study showed for the first time glomerular lesions developed in the Nx marmosets, and the possible pathogenesis of the glomerular lesions was discussed.

  20. Glomerular volume and renal histology in obese and non-obese living kidney donors.

    Science.gov (United States)

    Rea, D J; Heimbach, J K; Grande, J P; Textor, S C; Taler, S J; Prieto, M; Larson, T S; Cosio, F G; Stegall, M D

    2006-11-01

    The link between obesity and renal disease is unclear, and there is no consensus as to whether obese individuals are at increased risk for kidney disease after living kidney donation if they otherwise meet acceptance criteria. We retrospectively studied time-zero (implantation) biopsies in 49 obese (body mass index (BMI) > or = 30 kg/m2) and 41 non-obese (BMI < 30 kg/m2) renal donors that met acceptance criteria. We found that our obese donor population had higher systolic blood pressure (P < 0.001 vs non-obese) and higher absolute iothalamate clearance (P = 0.001 vs non-obese) before donation. The obese donors had larger glomerular planar surface area compared to non-obese controls (P = 0.017), and this parameter correlated with patient weight and urinary microalbumin excretion. Detailed examination of the biopsies revealed that although most histologic findings were similar between groups, the obese donors had more tubular dilation (P = 0.01), but less tubular vacuolization (P = 0.02) than the non-obese controls. There was also a trend toward more arterial hyalinosis in the obese patients than controls (P = 0.08). From these data, our studies detected subtle differences in donor organs obtained from obese compared to non-obese individuals. Further studies should be carried out to quantify the long-term impact of these findings.

  1. Impact of Pregnancy on Underlying Renal Disease

    OpenAIRE

    Baylis, Chris

    2003-01-01

    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progre...

  2. Feasibility study of high-resolution DCE-MRI for glomerular filtration rate (GFR) measurement in a routine clinical modal.

    Science.gov (United States)

    Zhang, Yu-Dong; Wu, Chen-Jiang; Zhang, Jing; Wang, Xiao-Ning; Liu, Xi-Sheng; Shi, Hai-Bin

    2015-10-01

    Dynamic contrast enhanced (DCE) MR renography has been identified as an interesting tool to determine single-kidney GFR. However, a fundamental issue for the applicability of MR-based estimate of single-kidney GFR is selecting a balance between spatial and temporal resolution of DCE-MRI data. The purpose is to assess the feasibility of GFR estimate from high-resolution (HR) dynamic contrast-enhanced (DCE) MRI in a routine clinical modal. Standard MR renography (2.4s/phase, total 4min; 4-ml Gd) and five-phase, HR-based imaging protocol (0, 30, 70, 120, and 240s; 0.05mmol/kg Gd) were prospectively performed in twelve volunteers who were scheduled for routine renal MRI. Data were plotted with Patlak, two-compartment modified Tofts model (2CTM), and two-compartment filtration model (2CFM) for GFR estimate. During all the measurements, only the signal intensities in the aorta and whole kidney parenchyma were considered. Standard 2CFM and 2CTM produced lower residuals over the fitted interval than HR-based measures (pGFR and higher residuals than that plots with 0-120s data points (pGFR with HR-based DCE-MRI and appreciate kinetic model. Patlak plots from 0, 30, 70, and 120s data points is better than plots from 0, 30, 70, 120, and 240s data points.

  3. Association of metabolic syndrome with decreased glomerular filtration rate among 75,468 Chinese adults: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Hui Song

    Full Text Available The impact of the various elements of metabolic syndrome (MetS on chronic kidney disease (CKD has been conflicting. Therefore, in the present study we aimed to examine the association of MetS and its components with decreased glomerular filtration rate (GFR.A total of 75,468 urban workers who underwent annual health examinations under the auspices of the local governments between March 2010 and September 2012 at the health examination center of Xuzhou center hospital were enrolled in the cross-sectional survey. Decreased GFR was defined as an estimated GFR <60 mL/min per 1.73 m2. The definition of MetS was based on the most-recent interim joint consensus definition, requiring any three of the five components, consisting of elevated blood pressure (BP, fasting plasma glucose (FPG, or triglycerides (TG, reduced high density lipoprotein-cholesterol (HDL-c, and obesity.MetS was related to the reduced GFR with an odds ratio [95% confidence interval (CI] of 1.43 (1.13-1.83. In multivariable analyses, individual components of MetS that were independently associated with decreased GFR were elevated BP (OR 1.34, 95% CI 1.00-1.78, low HDL-c (OR 1.88, 95% CI 1.44-2.43, and elevated FPG (OR 1.42, 95% CI 1.09-1.85. The age-adjusted population-attributable risk percent (PARP for reduced GFR was 27.55%, 19.67% and14.31% for elevated BP, low HDL-c and elevated FPG respectively. The multivariate-adjusted odds ratios (95% CI of decreased GFR were 1.70(1.11-2.60, 2.38(1.53-3.71, or 4.11(2.42-6.98 for those with 1, 2, or 3 critical elements (versus zero, respectively. The corresponding multivariate-adjusted odds ratios (95% CI of decreased GFR were 1.11(0.84-1.48 and 0.89(0.63-1.27 for those with 1 or 2 noncritical components (versus zero, respectively.We concluded that various elements of MetS and the cumulative number of MetS should not be considered indiscriminately as risk factors for reduced GFR.

  4. Decreased glomerular filtration rate is associated with mortality and cardiovascular events in patients with hypertension: a prospective study.

    Directory of Open Access Journals (Sweden)

    Rui Zhang

    Full Text Available BACKGROUND: Few studies reported the associations between decreased glomerular filtration rate (GFR and mortality, coronary heart disease (CHD, and stroke in hypertensive patients. We aim to assess the associations between GFR and mortality, CHD, and stroke in hypertensive patients and to evaluate whether low GFR can improve the prediction of these outcomes in addition to conventional cardiovascular risk factors. METHODS AND FINDINGS: This is an observational prospective study and 3,711 eligible hypertensive patients aged ≥5 years from rural areas of China were used for the present analysis. The associations between eGFR and outcomes, followed by a median of 4.9 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. Low eGFR was independently associated with risk of all-cause mortality, cardiovascular mortality, and incident stroke [multivariable adjusted hazard ratios (95% confidence intervals for eGFR <60 ml/min/1.73 m(2 relative to eGFR ≥90 ml/min/1.73 m(2 were 1.824 (1.047-3.365, 2.371 (1.109-5.068, and 2.493 (1.193-5.212, respectively]. We found no independent association between eGFR and the risk of CHD. For 4-year all-cause and cardiovascular mortality, integrated discrimination improvement (IDI was positive when eGFR were added to traditional risk factors (1.51%, P = 0.016, and 1.99%, P = 0.017, respectively. For stroke and CHD events, net reclassification improvements (NRI were 5.9% (P = 0.012 and 1.8% (P = 0.083 for eGFR, respectively. CONCLUSIONS: We have established an inversely independent association between eGFR and all-cause mortality, cardiovascular mortality, and stroke in hypertensive patients in rural areas of China. Further, addition of eGFR significantly improved the prediction of 4-year mortality and stroke over and above that of conventional risk factors. We recommend that eGFR be incorporated into prognostic assessment for patients with hypertension in

  5. Effect of Vitamin D Receptor Activators on Glomerular Filtration Rate: A Meta-Analysis and Systematic Review.

    Directory of Open Access Journals (Sweden)

    Qian Zhang

    Full Text Available Vitamin D receptor activators (VDRAs can protect against mineral bone disease, but they are reported to elevate serum creatinine (SCr and may also reduce glomerular filtration rate (GFR.We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs to evaluate the effect of VDRAs on kidney function and adverse events. MEDLINE, EMBASE, the Cochrane Controlled Trials Register were searched for RCTs that evaluate vitamin D receptor activators (alfacalcidol, calcitriol, doxercalciferol, falecalcitriol, maxacalcitol and paricalcitol up to March 2015.We included 31 studies, all of which were performed between 1976 and 2015, which enrolled 2621 patients. Patients receiving VDRAs had lower eGFR (weighted mean difference WMD -1.29 mL/min /1.73 m2, 95% CI -2.42 to -0.17 and elevated serum creatinine (WMD 7.03 μmol/L, 95% CI 0.61 to 13.46 in sensitivity analysis excluding studies with dropout rate more than 30%. Subgroup analysis of the 5 studies that not use SCr-based measures did not indicated lower GFR in the VDRAs group(WMD -0.97 mL/min/1.73 m2, 95% CI -4.85 to 2.92. Compared with control groups, there was no difference in all-cause mortality (relative risk RR 1.41, 95% CI 0.58 to 3.80, cardiovascular disease (RR 0.84, 95% CI 0.42 to 1.71, and severe adverse events (RR 1.15, 95% CI 0.75 to 1.77 for the VDRAs groups. Episodes of hypercalcemia (RR 3.29, 95% CI 2.02 to 5.38 were more common in the VDRAs group than in the control group.Administration of VDRAs increased serum creatinine levels. Subgroup analysis of studies that did not use SCr-based measures did not indicate a lower GFR in the VDRA group. Future studies with non-SCr-based measures are needed to assess whether the mild elevations of serum creatinine are of clinical significance.

  6. Effects of body mass index and age on N-terminal pro brain natriuretic peptide are associated with glomerular filtration rate in chronic heart failure patients

    DEFF Research Database (Denmark)

    Schou, Morten; Gustafsson, Finn; Kistorp, Caroline N

    2007-01-01

    BACKGROUND: Obesity is a state characterized by glomerular hyperfiltration and age-related decreases in glomerular filtration rate (GFR). Body mass index (BMI), age, and GFR are associated with plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) in chronic heart failure...... (CHF) patients. We hypothesized that the effects of BMI and age on plasma concentrations of NT-proBNP are associated with GFR. METHODS: We obtained clinical data and laboratory test results from 345 CHF patients at the baseline visit in our heart failure clinic and examined the hypothesis using...... multiple linear regression models. RESULTS: Age (P = 0.0184), BMI (P = 0.0098), hemoglobin (P = 0.0043), heart rhythm (P proBNP). After adjustment for GFR estimated by the Cockcroft and Gault equation, the parameter...

  7. Relationship of serum RBP, NEFA and FKN content with urinary protein excretion and glomerular filtration function damage in patients with early diabetic nephropathy

    Institute of Scientific and Technical Information of China (English)

    Zhi Yang; Ji Zhang; Li-Ping Tang

    2016-01-01

    Objective:To analyze the relationship of serum RBP, NEFA and FKN content with urinary protein excretion and glomerular filtration function damage in patients with early diabetic nephropathy.Methods: A total of 76 patients with early diabetic nephropathy were included in observation group and 80 healthy subjects were included in control group. Differences in retinol-binding protein (RBP), non-esterified fatty acid (NEFA) and chemokine Fractalkine (FKN) content in serum as well as urinary protein excretion indexes and glomerular filtration function indexes were compared between the two groups immediately after admission, and the correlation of RBP, NEFA and FKN content with the disease was further analyzed.Results:Serum RBP, NEFA and FKN content of observation group were higher than those of control group; 24 h total urine volume, 24 h urinary albumin and urinary albumin excretion rate as well as urine-specific proteins Kim-1, NGAL, L-FABP and CysC content of observation group were higher than those of control group and positively correlated with serum RBP, NEFA and FKN content; GFR level of observation group was lower than that of control group and negatively correlated with serum RBP, NEFA and FKN content while serum Cr, BUN, VF, LP-a,β2-MG and HA content were higher than those of control group and positively correlated with serum RBP, NEFA and FKN content.Conclusions:Serum RBP, NEFA and FKN content significantly increase in patients with early diabetic nephropathy and are correlated with urinary protein excretion and glomerular filtration function damage.

  8. Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke: a result from the Kailuan study.

    Science.gov (United States)

    Li, Z; Wang, A; Cai, J; Gao, X; Zhou, Y; Luo, Y; Wu, S; Zhao, X

    2015-02-01

    Persons with chronic kidney disease, defined by a reduced estimated glomerular filtration rate and proteinuria, have an increased risk of cardiovascular disease including stroke. However, data from developing countries are limited. Our aim was to assess the relationship between chronic kidney disease and risk of stroke and its subtypes in a community-based population in China. The study was based on 92,013 participants (18-98 years old; 73,248 men and 18,765 women) of the Kailuan study who at baseline were free from stroke and myocardial infarction and had undergone tests for serum creatinine or proteinuria. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration formula and proteinuria by the urine dipstick result in laboratory databases. The primary outcome was the first occurrence of stroke. Data were analyzed using Cox proportional hazards models adjusted for relevant confounders and results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). During a follow-up of 4 years, 1575 stroke events (1128 ischaemic, 406 intracerebral hemorrhagic and 41 subarachnoid hemorrhagic strokes) occurred. After adjustment for variable confounders, patients with proteinuria were found to have increased HRs for the total and subtypes of stroke events (HR 1.61; 95% CI 1.35-1.92 for total stroke; HR 1.53; 95% CI 1.24-1.89 for ischaemic stroke; and HR 1.90; 95% CI 1.35-2.67 for hemorrhagic stroke). However, estimated glomerular filtration rate was not associated with incident stroke after adjustment for established cardiovascular risk factors. Proteinuria increased the risk of stroke in a general Chinese population. © 2014 EAN.

  9. Estimating glomerular filtration rate equation and medical laboratory%估算肾小球滤过率的建立与医学检验

    Institute of Scientific and Technical Information of China (English)

    潘柏申

    2014-01-01

    Estimating glomerular filtration rate is very useful in the management of chronic kidney disease.The clinical laboratories should understand these eGFR equations.%估算肾小球滤过率在慢性肾脏疾病的诊断治疗中有着重要临床意义。了解这些eGFR公式的发展和临床应用过程,可以得到一些有价值的启示。(中华检验医学杂志,2014,37:401-403)

  10. Applicability of the Schwartz Equation and the Chronic Kidney Disease in Children Bedside Equation for Estimating Glomerular Filtration Rate in Overweight Children.

    Science.gov (United States)

    Lewis, Teresa V; Harrison, Donald L; Gildon, Brooke L; Carter, Sandra M; Turman, Martin A

    2016-06-01

    To determine if significant correlations exist between glomerular filtration rate (GFR) prediction equation values, derived by using the original Schwartz equation and the Chronic Kidney Disease in Children (CKiD) bedside equation with a 24-hour urine creatinine clearance (Clcr ) value normalized to a body surface area of 1.73 m(2) in overweight and obese children. Prospective analysis (20 patients) and retrospective analysis (43 patients). Pediatric inpatient ward and pediatric nephrology clinic at a comprehensive academic medical center. Sixty-three pediatric patients (aged 5-17 years), of whom 27 were overweight (body mass index [BMI] at the 85th percentile or higher) and 36 were not overweight (BMI lower than the 85th percentile [controls]) between 2007 and 2012. Data from the overweight patients were compared with nonoverweight controls. GFR values were calculated by using the original Schwartz equation and the CKiD bedside equation. Each patient's 24-hour urine Clcr value normalized to a body surface area of 1.73 m(2) served as the index value. A Pearson correlation coefficient model was used to determine association between the 24-hour urine Clcr value (index value) with the Schwartz and CKiD GFR estimations. Significant correlation was found to exist between the Schwartz and CKiD bedside GFR estimations relative to the 24-hour urine Clcr in the control subjects (r = 0.85, pSchwartz and CKiD bedside GFR values with the 24-hour urine Clcr value in overweight subjects (r = 0.86, pSchwartz equation estimated average GFR 21.75 ml/minute/1.73 m(2) higher than 24-hour urine Clcr (pSchwartz and CKiD bedside estimations of GFR correlated with 24-hour urine Clcr values in both overweight and nonoverweight children. Compared with the Schwartz equation, which tended to overestimate renal function, the CKiD bedside equation appeared to approximate 24-hour urine Clcr more closely in overweight children with kidney disorder. © 2016 Pharmacotherapy Publications, Inc.

  11. An epidemiologic model to project the impact of changes in glomerular filtration rate on quality of life and survival among persons with chronic kidney disease.

    Science.gov (United States)

    Levy, Adrian R; Perkins, Robert M; Johnston, Karissa M; Sullivan, Sean D; Sood, Vipan C; Agnese, Wendy; Schnitzler, Mark A

    2014-01-01

    Predicting the timing and number of end-stage renal disease (ESRD) cases from a population of individuals with pre-ESRD chronic kidney disease (CKD) has not previously been reported. The objective is to predict the timing and number of cases of ESRD occurring over the lifetime of a cohort of hypothetical CKD patients in the US based on a range of baseline estimated glomerular filtration rate (eGFR) values and varying rates of eGFR decline. A three-state Markov model - functioning kidney, ESRD, and death - with an annual cycle length is used to project changes in baseline eGFR on long-term health outcomes in a hypothetical cohort of CKD patients. Using published eGFR-specific risk equations and adjusting for predictive characteristics, the probability of ESRD (eGFR projected over the cohort's lifetime under two scenarios: an acute drop in eGFR (mimicking acute kidney injury) and a reduced hazard ratio for ESRD (mimicking an effective intervention). Among CKD patients aged 50 years, an acute eGFR decrement from 45 mL/minute to 35 mL/minute yields decreases of 1.6 life-years, 1.5 quality-adjusted life-years (QALYs), 0.8 years until ESRD, and an increase of 183 per 1,000 progressing to ESRD. Among CKD patients aged 60 years, lowering the hazard ratio of ESRD to 0.8 yields values of 0.2, 0.2, 0.2, and 46 per 1,000, respectively. Incremental cost-effectiveness ratios are higher (ie, less favorable) for higher baseline eGFR, indicating that interventions occurring later in the course of disease are more likely to be economically attractive. Both acute kidney injury and slowing the rate of eGFR decline produce substantial shifts in expected numbers and timing of ESRD among CKD patients. This model is a useful tool for planning management of CKD patients.

  12. Research progress of estimating glomerular filtration rate in chronic kidney disease%估算肾小球滤过率在慢性肾脏疾病诊疗中的研究现状

    Institute of Scientific and Technical Information of China (English)

    王蓓丽; 郭玮; 潘柏申

    2014-01-01

    The mortality of chronic kidney disease (CKD) is increasing because of renal failure,cardiovascular diseases and other reasons which has been a global public health problem.Glomerular filtration rate (GFR) is the important biomarker of kidney function evaluation and early diagnosis of CKD,whose direct measurement methods cannot be widely applied in clinical laboratory.With the development of studies on estimating glomerular filtration rate (eGFR) equations,eGFR has been a biomarker of kidney function evaluation in clinical diagnosis.The current paper reviews the research progress and clinical application of different eGFR equations.%慢性肾脏疾病(CKD)患者由于肾功能衰竭、心血管疾病等原因死亡率较高,已成为社会广泛关注的医疗问题.肾小球滤过率(GFR)是评估肾脏功能和早期诊断CKD的重要标志物,但GFR直接检测法无法广泛应用于临床常规检测.随着各类估算肾小球滤过率(eGFR)公式的研究报道,eGFR已成为临床评估患者肾脏功能的重要指标之一.本文综述了不同估算肾小球滤过率公式的研究进展及其在临床诊疗中的应用.

  13. Control of glomerular hypertension by insulin administration in diabetic rats.

    Science.gov (United States)

    Scholey, J W; Meyer, T W

    1989-01-01

    Micropuncture studies were performed in Munich Wistar rats made diabetic with streptozotocin and in normal control rats. Diabetic rats received daily ultralente insulin to maintain moderate hyperglycemia (approximately 300 mg/dl). Group 1 diabetic rats studied after routine micropuncture preparation exhibited elevation of the single nephron glomerular filtration rate (SNGFR) due to increases in the glomerular transcapillary hydraulic pressure difference and glomerular plasma flow rate. In group 2 diabetic rats infusion of insulin to achieve acute blood glucose control normalized the glomerular transcapillary pressure gradient while increasing the glomerular ultrafiltration coefficient, so that SNGFR remained elevated. Persistent elevation of SNGFR despite normalization of the transcapillary pressure gradient was also observed in group 3 diabetic rats infused with insulin plus sufficient dextrose to maintain hyperglycemia. These studies indicate that glomerular capillary hypertension in diabetes is an acutely reversible consequence of insulin deficiency and not the result of renal hypertrophy. PMID:2649514

  14. Estimation of glomerular filtration rate with different background region of interest for renography in severe renal insufficiency patients%肾动态显像中不同本底的选取在重度肾功能不全患者肾小球滤过率的评估

    Institute of Scientific and Technical Information of China (English)

    杜晓英; 朱阳军; 李林法; 何强; 陈江华

    2008-01-01

    Objective To evaluate the improvement of diagnostic accuracy with background region of interest(ROI)rectification for 99mTc-DTPA renography in patients with GFR≤plasma sampling method). Methods Thirty-three patients(age>20 years,male/female=13/20)dose of 111 MBq/0.5 ml of 99mTc-DTPA was injected into an antecubital vein.The background ROI was selected below the kidney(Gates method,method a)or around the kidney(method b),then these two different GFR(GFRa,GFRb)were automatically estimated by computer.Meanwhile,3 ml blood samples were collected 2 h and 4 h after injection respectively,and radioactivity of 1 ml plasma was measured.GFR was calculated by dual plasma sampling method(GFRp)and the results were all standardized with the body surface area.The accuracies and correlations of GFRa and GFRb were compared to GFRp respectively. Results The correlation coefficients were ra=0.602 and rb=0.834.The median of difference of GFRa and GFRb was 8.33,-4.41.The median of absolute difference of GFRa and GFRb was 8.33,4.49.The accuracies within±15%,±30%and±50%of GFRa were 24.2%,30.3%and 48.5%,and those of GFRb were 33.3%,51.5%and 81.8%.Conclusion The background ROI around kidney can obviously improve the diagnostic accuracy of 99mTc-DTPA renography in patients with severe renal insufficiency.%目的 以99mTc-DTPA血浆清除率为标准,评价在重度肾功能不全[GFR≤30 ml·min-1·(1.73 m2)-1]患者GFR的评估中,本底矫正在提高99mTc-DTPA肾动态显像检查准确性中的价值.方法 选择重度慢性肾脏病患者33例,年龄均>20岁,男性/女性=13/20,平均Scr334 μmol/L,诊断均符合美国NKF-K/DOQI关于慢性肾脏病定义.排除肾功能急性恶化因素、水肿、肢体缺如及心功能不全.分别检测患者身高、体质量.常规99mTc-DTPA肾动态功能显像,采用双肾下极(传统Gates法,a法)及肾周环形勾画法(b法)获取图像本底,并分别由计算机自动计算GFR值(GFRa和GFRb).于注射后2 h、4 h各抽血4

  15. Multiphoton imaging of the glomerular permeability of angiotensinogen.

    Science.gov (United States)

    Nakano, Daisuke; Kobori, Hiroyuki; Burford, James L; Gevorgyan, Haykanush; Seidel, Saskia; Hitomi, Hirofumi; Nishiyama, Akira; Peti-Peterdi, Janos

    2012-11-01

    Patients and animals with renal injury exhibit increased urinary excretion of angiotensinogen. Although increased tubular synthesis of angiotensinogen contributes to the increased excretion, we do not know to what degree glomerular filtration of systemic angiotensinogen, especially through an abnormal glomerular filtration barrier, contributes to the increase in urinary levels. Here, we used multiphoton microscopy to visualize and quantify the glomerular permeability of angiotensinogen in the intact mouse and rat kidney. In healthy mice and Munich-Wistar-Frömter rats at the early stage of glomerulosclerosis, the glomerular sieving coefficient of systemically infused Atto565-labeled human angiotensinogen (Atto565-hAGT), which rodent renin cannot cleave, was only 25% of the glomerular sieving coefficient of albumin, and its urinary excretion was undetectable. In a more advanced phase of kidney disease, the glomerular permeability of Atto565-hAGT was slightly higher but still very low. Furthermore, unlike urinary albumin, the significantly higher urinary excretion of endogenous rat angiotensinogen did not correlate with either the Atto565-hAGT or Atto565-albumin glomerular sieving coefficients. These results strongly suggest that the vast majority of urinary angiotensinogen originates from the tubules rather than glomerular filtration.

  16. Utility of Double Filtration Plasmapheresis in Acute Antibody Mediated Renal Allograft Rejection: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Yalçın SOLAK

    2011-09-01

    Full Text Available Plasmapheresis is an extracorporeal procedure, which is often employed to rapidly lower circulating titers of autoantibodies, immune complexes or toxins. There are two types of plasmapheresis namely, regular plasmapheresis (RPP by centrifugation and membrane filtration, and double filtration plasmapheresis (DFPP which is a special form of membrane filtration in which two membranes called as plasma separator and plasma fractionator are employed to filter macromolecules more selectively. DFPP have several advantages over RP. Despite widespread utilization of DFPP in the setting of ABO blood group incompatible kidney transplantation, there is no report regarding DFPP in patients with antibody mediated acute renal allograft rejection who are good candidates for beneficial effects of DFPP. Here we report three renal transplant recipients in whom DFPP was applied as a component of anti-rejection treatment regimen.

  17. Permeation of macromolecules into the renal glomerular basement membrane and capture by the tubules

    Science.gov (United States)

    Lawrence, Marlon G.; Altenburg, Michael K.; Sanford, Ryan; Willett, Julian D.; Bleasdale, Benjamin; Ballou, Byron; Wilder, Jennifer; Li, Feng; Miner, Jeffrey H.; Berg, Ulla B.; Smithies, Oliver

    2017-01-01

    How the kidney prevents urinary excretion of plasma proteins continues to be debated. Here, using unfixed whole-mount mouse kidneys, we show that fluorescent-tagged proteins and neutral dextrans permeate into the glomerular basement membrane (GBM), in general agreement with Ogston's 1958 equation describing how permeation into gels is related to molecular size. Electron-microscopic analyses of kidneys fixed seconds to hours after injecting gold-tagged albumin, negatively charged gold nanoparticles, and stable oligoclusters of gold nanoparticles show that permeation into the lamina densa of the GBM is size-sensitive. Nanoparticles comparable in size with IgG dimers do not permeate into it. IgG monomer-sized particles permeate to some extent. Albumin-sized particles permeate extensively into the lamina densa. Particles traversing the lamina densa tend to accumulate upstream of the podocyte glycocalyx that spans the slit, but none are observed upstream of the slit diaphragm. At low concentrations, ovalbumin-sized nanoparticles reach the primary filtrate, are captured by proximal tubule cells, and are endocytosed. At higher concentrations, tubular capture is saturated, and they reach the urine. In mouse models of Pierson’s or Alport’s proteinuric syndromes resulting from defects in GBM structural proteins (laminin β2 or collagen α3 IV), the GBM is irregularly swollen, the lamina densa is absent, and permeation is increased. Our observations indicate that size-dependent permeation into the lamina densa of the GBM and the podocyte glycocalyx, together with saturable tubular capture, determines which macromolecules reach the urine without the need to invoke direct size selection by the slit diaphragm. PMID:28246329

  18. Renal disease in pregnancy.

    Science.gov (United States)

    Thorsen, Martha S; Poole, Judith H

    2002-03-01

    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  19. Comparison between a serum creatinine-and a cystatin C-based glomerular filtration rate equation in patients receiving amphotericin B.

    Science.gov (United States)

    Karimzadeh, Iman; Khalili, Hossein

    2016-06-06

    Serum cystatin C (Cys C) has a number of advantages over serum creatinine in the evaluation of kidney function. Apart from Cys C level itself, several formulas have also been introduced in different clinical settings for the estimation of glomerular filtration rate (GFR) based upon serum Cys C level. The aim of the present study was to compare a serum Cys C-based equation with Cockcroft-Gault serum creatinine-based formula, both used in the calculation of GFR, in patients receiving amphotericin B. Fifty four adult patients with no history of acute or chronic kidney injury having been planned to receive conventional amphotericin B for an anticipated duration of at least 1 week for any indication were recruited. At three time points during amphotericin B treatment, including days 0, 7, and 14, serum cystatin C as well as creatinine levels were measured. GFR at the above time points was estimated by both creatinine (Cockcroft-Gault) and serum Cys C based equations. There was significant correlation between creatinine-based and Cys C-based GFR values at days 0 (R = 0.606, P = 0.001) and 7 (R = 0.714, P creatinine-and a cystatin C-based glomerular filtration rate equation in patients receiving amphotericin B.

  20. RENAL GLOMERULAR NUMBER AND SIZE IN AUSTRALIAN ABORIGINES, AFRICAN AMERICANS AND WHITE POPULATIONS FROM THE SAME LOCATIONS: A PRELIMINARY REPORT

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    John F Bertram

    2011-05-01

    Full Text Available End stage renal disease is a major health problem for Australian Aborigines and African Americans. Abnormally enlarged glomeruli are commonly observed in biopsies from Aborigines and African Americans and may represent a compensatory hypertrophic response to reduced nephron endowment. We have commenced a study examining glomerular number and size, and their associations in Australian Aborigines and whites, and US African Americans and whites. Kidneys at autopsy are perfusion-fixed and subsampled for stereological estimation of total glomerular number (Nglom; using the physical disector/fractionator combination, and mean renal corpuscle (Vcorp and glomerular volume (Vglom. Kidneys from 58 people have been studied to date with ages ranging from newborn to 84 years. Preliminary findings are: (1 an almost 9-fold range in Nglom (from 210,332 to 1,825,380 with a mean of 762,302; (2 Nglom decreased with age in adult life (p = 0.014; (3 Vcorp varied 19-fold in the series and 5.5-fold in adults; (4 Vglom was inversely correlated with Nglom (p = 0.004; (5 total renal corpuscle volume (Nglom × Vcorp ranged by a factor of 13.2; (6 kidney weight was correlated with body surface area (BSA at all ages (p < 0.001; (7 BSA-corrected kidney weight did not vary with age, it ranged from 47 g/m2 to 175 g/m2, a 3.7 fold difference, with an average of 92 ± 25 g/m2. These preliminary results have revealed several new and important correlations. No racial differences in glomerular number or size have yet been identified, but with greater sample sizes such differences may be revealed.

  1. Association of Estimated Glomerular Filtration Rate with Hemoglobin Level in Korean Adults: The 2010-2012 Korea National Health and Nutrition Examination Survey.

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    Sang Youb Han

    Full Text Available Little is known about anemia in patients with early renal dysfunction. We aimed to investigate the association of hemoglobin level and anemia prevalence with estimated glomerular filtration rate (eGFR decline using a nation-wide representative sample of the adult Korean population.In total, 17,373 participants (7,296 men; weighted n = 18,330,187; mean age, 44.2±0.3 years; 9,886 women, weighted n = 18,317,454; mean age, 46.9±0.3 years were included. eGFR was divided into 5 groups: Group 1, ≥105; Group 2, 90-104; 75-89; Group 4, 60-74; and Group 5, <60 mL/min/1.73m2.The weighted anemia prevalence rates were 2.6% in men and 12.8% in women. In men, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked at an eGFR of 60-89 mL/min/1.73m2 and decreased thereafter at an eGFR of <60 mL/min/1.73m2 (15.19±0.03, 15.35±0.03, 15.53±0.03, 15.52±0.06, and 14.90±0.12 g/dL from Groups 1 to 5 after adjustment for age, college graduation, cancer history, current smoking, waist circumference, serum cholesterol level, serum triglyceride level, and diastolic blood pressure. In women, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked with an eGFR of 75-89 mL/min/1.73m2 and decreased thereafter (12.90±0.03, 13.08±0.02, 13.20±0.04, 13.14±0.05, and 12.47±0.11 g/dL from Groups 1 to 5 after adjustment for menstruation, pregnancy, estrogen replacement, and the above-mentioned variables. In both sexes, the weighted prevalence of anemia with an eGFR of 60-104 mL/min/1.73m2 was significantly lower than that with an eGFR of ≥105 mL/min/1.73m2 (men, 3.2±0.4%, 1.9±0.3%, 1.8±0.3%, 2.0±0.9%, and 18.1±3.1%; women, 14.0±0.8%, 11.2±0.7%, 10.5±1.0%, 13.2±1.6%, and 32.3±3.2% from Groups 1 to 5.We noted a compensatory increase in the hemoglobin level with a minor decline in kidney function (in the range of eGFR ≥60 mL/min/1.73m2 prior to a marked decrease in hemoglobin level with severe renal

  2. An epidemiologic model to project the impact of changes in glomerular filtration rate on quality of life and survival among persons with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Levy AR

    2014-07-01

    Full Text Available Adrian R Levy,1,2 Robert M Perkins,3 Karissa M Johnston,2 Sean D Sullivan,4 Vipan C Sood,5 Wendy Agnese,5 Mark A Schnitzler61Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; 2Oxford Outcomes Ltd, Vancouver, BC, Canada; 3Center for Health Research and Division of Nephrology, Geisinger Health System, Danville, PA, USA; 4School of Pharmacy, University of Washington, Seattle, WA, USA; 5Mitsubishi Tanabe Pharma America, Jersey City, NJ, USA; 6Departments of Internal Medicine and Community Health, Saint Louis University, St Louis, MO, USAPurpose: Predicting the timing and number of end-stage renal disease (ESRD cases from a population of individuals with pre-ESRD chronic kidney disease (CKD has not previously been reported. The objective is to predict the timing and number of cases of ESRD occurring over the lifetime of a cohort of hypothetical CKD patients in the US based on a range of baseline estimated glomerular filtration rate (eGFR values and varying rates of eGFR decline.Methods: A three-state Markov model – functioning kidney, ESRD, and death – with an annual cycle length is used to project changes in baseline eGFR on long-term health outcomes in a hypothetical cohort of CKD patients. Using published eGFR-specific risk equations and adjusting for predictive characteristics, the probability of ESRD (eGFR <10, time to death, and incremental cost-effectiveness ratios for hypothetical treatments (costing US$10, $5, and $2/day, are projected over the cohort's lifetime under two scenarios: an acute drop in eGFR (mimicking acute kidney injury and a reduced hazard ratio for ESRD (mimicking an effective intervention.Results: Among CKD patients aged 50 years, an acute eGFR decrement from 45 mL/minute to 35 mL/minute yields decreases of 1.6 life-years, 1.5 quality-adjusted life-years (QALYs, 0.8 years until ESRD, and an increase of 183 per 1,000 progressing to ESRD. Among CKD patients aged 60 years, lowering

  3. Application of glomerular filtration rate estimating equations in patients with diabetes%肾小球滤过率估算公式在糖尿病患者中的应用

    Institute of Scientific and Technical Information of China (English)

    吴楠

    2011-01-01

    Diabetic kidney disease (DKD) is the most common microvascular complications of diabetes and the main cause of chronic kidney disease and end-stage renal disease (ESRD). Because of its incidence of occult, poor prognosis and high cost, it is essential to raising awareness of DKD, making a reasonable assessment of golmerular filtration rate (GFR) and taking effective intervention to prevent disease progression as early as possible, which is also important for preventing serious complications of the kidney. Many clinicians have recognized the importance of stratifying chronic kidney disease (CKD)in diabetic subjests. This article reviews recent literature of application of equations to estimate GFR in patients with diabetes to wake a general review.%糖尿病肾脏疾病(diabetic kidney disease,DKD)是糖尿病最常见的微血管并发症,是慢性肾脏疾病及终末期肾病(end-stage renal disease,ESRD)的首因,其发病隐匿且预后不佳,治疗费用极为昂贵.提高对DKD的早期认识,对GFR进行合理性评估,早期采取有力干预手段能预防疾病恶化.目前越来越多的临床医师认识到进行慢性肾脏疾病(chronic kidney disease,CKD)分期的重要性,但目前尚未确立适合于糖尿病患者的肾小球滤过率(glomerular filtration rate,GFR)评估公式.本文回顾近年来的文献资料,就GFR估算公式在糖尿病患者中的应用做一系统综述.

  4. Study of cystatin C (Cys C in relation to the calculation of the glomerular filtration rate and bioelectrical impedance analysis parameters in obese patients with and without type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Mario Liani

    2012-01-01

    Full Text Available IntroductionAssessment of renal function based on quantification of the glomerular filtration rate (GFR is essential for early detection of damage and progression of renal diseases. The purpose of our study was to determine the value of cystatin C (Cys C assays in the calculation of the GFR and bioelectrical impedance analysis parameters in obese subjects aged 30-70 years with moderately damaged renal function.Materials and methodsCys C levels were measured with a new immunoturbidimetric kit (Roche Diagnostics and an automated Cobas c6000 analyzer. In the GFR calculation, creatinine and Cys C levels were included. The GFR calculated with the equation that included Cys C in obese and normal-weight patients is not affected by changes in the lean body mass.ResultsObese patients (N = 70 had a mean (± SD serum creatinine level of 1.52 ± 1.0 mg/dL and a mean Cys C level of 1.28 ± 0.59 mg/L. In this group, the GFR calculated on the basis of MDRD, Cys C, and creatinine clearance values showed similar filtered values between MDRD and Cys C and a DS value smaller in the case of Cys C. The correlation (R2 between GFR and its metabolite is higher in the case of Cys C when somatotype parameters (measured with bioelectrical impedance analysis were introduced into the equation.ConclusionsWhen Cys C is included in calculations of GFR, the result shows a higher correlation degree compared to the MDRD system. Given that Cys C shows less intra-individual variability than creatinine, it can be applied in routine diagnostics in a larger number of patients.

  5. Relationship between plasma creatinine concentration and glomerular filtration in preterm newborn infants Creatinina sanguínea em recém-nascido pré-termo e sua relação com a filtração glomerular

    Directory of Open Access Journals (Sweden)

    Mário Cícero Falcão

    1999-08-01

    Full Text Available Fluid management and dosage regimens of drugs in preterm infants should be based on the glomerular filtration rate. The current methods to determine glomerular flitration rate are invasive, time-consuming, and expensive. In contrast, creatinine clearance can be easy obtained and quickly determined. The purpose of this study was to compare plasma creatinine on the third and seventh day of life in preterm newborn infants, to evaluate the influence of maternal creatinine, and to demonstrate creatinine clearance can be used as a reliable indicator of glomerular filtration rate. We developed a prospective study (1994 including 40 preterm newborns (gestational age 1ml/kg/hr; normal blood pressure; absence of infections and no sympathomimetic amines in use. A blood sample was collected to determine plasma creatinine (enzymatic method on the third and seventh day of life and creatinine clearance (CrCl was obtained using the following equation: , k = 0.33 in preterm infant All plasma creatinine determinations showed normal values [third day: 0.78 mg/dl ± 0.24 (mean ± SDand seventh day: 0.67 mg/dl ± 0.31 - (p>0.05]. Also all creatinine clearance at third and seventh day of life were normal [third day: 19.5 ml/min ± 5.2 (mean ± SD and seventh day: 23.8 ml/min ± 7.3 - (p>0,05]. All preterm infants developed adequate renal function for their respective gestational age. In summary, our results indicate that, for clinical practice, the creatinine clearance, using newborn length, can be used to estimate glomerular filtration rate in preterm newborn infants.Na prática neonatal é importante a verificação da função de filtração glomerular para que o manuseio de recém-nascidos pré-termo seja facilitado. Métodos específicos são demorados, tecnicamente difíceis, invasivos e dispendiosos. Para tal, métodos simples e eficazes são benvindos. A determinação do clearance de creatinina se encaixa facilmente nestes quesitos. Esta pesquisa teve como

  6. Aberrant glomerular filtration of urokinase-type plasminogen activator in nephrotic syndrome leads to amiloride-sensitive plasminogen activation in urine

    DEFF Research Database (Denmark)

    Staehr, Mette; Buhl, Kristian B; Andersen, René F

    2015-01-01

    (uPA) in vitro. It was hypothesized that uPA is abnormally filtered to pre-urine and is inhibited in urine by amiloride in nephrotic syndrome. This was tested by determination of Na+-balance, uPA protein and activity and amiloride concentration in urine from rats with puromycin aminonucleoside (PAN......In nephrotic syndrome, aberrant glomerular filtration of plasminogen and conversion to active plasmin in pre-urine is thought to activate proteolytically ENaC and contribute to sodium retention and edema. The ENaC blocker amiloride is an off-target inhibitor of urokinase-type plasminogen activator......) induced nephrotic syndrome. Urine samples from 6 adult and 18 pediatric patients with nephrotic syndrome were analyzed for uPA activity and protein. PAN-treatment induced significant proteinuria in rats which coincided with increased urine uPA protein and activity, increased urine protease activity...

  7. 肾小球滤过功能检查的方法学进展%Advance in methodology on detecting the glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    罗侃; 崔有宏; 韩平治

    2005-01-01

    肾小球滤过率(Glomerular filtration rate,GFR)和肾血浆清除率(Clearance)测定是两个在概念上既有联系但又有区别的临床试验。前者表示单位时间(s或min)内从双肾滤过的血浆毫升数,为测定总肾和分肾肾小球滤过功能的重要指标;后者系指双肾于单位时间内,能将若干毫升血浆中所含的某物质全部加以清除,它既可以用来测定肾小球滤过率,

  8. Evaluation of the various methods in detecting glomerular filtration rate%肾小球滤过功能检查方法评价

    Institute of Scientific and Technical Information of China (English)

    辛岗; 李惊子

    2002-01-01

    @@ 肾小球的主要功能为滤过作用,反映其滤过功能的主要客观指标为肾小球滤过率(glomerular filtration rate,GFR).肾小球滤过率是指单位时间(min)从双肾滤过的血浆的毫升数.GFR不能直接测定,只能通过某种标志物的清除率的测定而得知.标志物的清除率是指单位时间内肾脏排出这种物质的总量,计算公式如下:

  9. Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study.

    Science.gov (United States)

    Selistre, Luciano; Rabilloud, Muriel; Cochat, Pierre; de Souza, Vandréa; Iwaz, Jean; Lemoine, Sandrine; Beyerle, Françoise; Poli-de-Figueiredo, Carlos E; Dubourg, Laurence

    2016-03-01

    Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (interquartile range [IQR] of the ratio) and accuracy (percentage of estimated GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR). In the whole sample, the mean ratio with the CKD-EPI equation was significantly higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08 [95% CI 1.07; 1.09], p Schwartz equation were closer to 1 than the mean ratios with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus 1.15 [95% CI 1.13; 1.16], p Schwartz equation had a better precision and was also more accurate than the CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28; 0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8 [95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all patients aged ≥65 y, the CKD-EPI equation performed better than the Schwartz equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30: 77.6 [95% CI 75.7; 79

  10. Association between serum insulin-like growth factor I or IGF-binding protein 3 and estimated glomerular filtration rate: results of a population-based sample

    Directory of Open Access Journals (Sweden)

    Dittmann Kathleen

    2012-12-01

    Full Text Available Abstract Background Insulin-like growth factor I (IGF-I, which is mostly carried in blood by IGF-binding protein 3 (IGFBP-3, was associated to the glomerular filtration rate and chronic kidney disease in a multiethnic study among US adults. The aim of the present study was to investigate whether serum IGF-I or IGFBP-3 are associated with estimated glomerular filtration rate (eGFR in a population-based study of Caucasian adults. Methods Data from 4028 subjects (2048 women aged 20 to 81 years from the Study of Health in Pomerania (SHIP were analyzed. Total serum IGF-I and IGFBP-3 concentrations were determined by chemiluminescence immunoassays and categorized into sex- and age-specific quartiles. Results After adjusting for age, waist circumference and type 2 diabetes mellitus, analysis of variance (ANOVA revealed inverse associations between serum IGF-I concentrations and eGFR in men as well as between serum IGFBP-3 concentrations and eGFR in men and women. Logistic regression analyses confirmed these findings and showed that high IGF-I or IGFBP-3 concentrations were associated with an increased risk of decreased eGFR (2 in men or women. These relations became stronger when lower eGFR cut-offs were used for the analyses. Conclusion Our data revealed associations of increased serum IGF-I concentrations and decreased eGFR in men but not in women and an association of increased serum IGFBP-3 concentrations and decreased eGFR in both sexes.

  11. Cell biology of mesangial cells: the third cell that maintains the glomerular capillary.

    Science.gov (United States)

    Kurihara, Hidetake; Sakai, Tatsuo

    2017-03-01

    The renal glomerulus consists of glomerular endothelial cells, podocytes, and mesangial cells, which cooperate with each other for glomerular filtration. We have produced monoclonal antibodies against glomerular cells in order to identify different types of glomerular cells. Among these antibodies, the E30 clone specifically recognizes the Thy1.1 molecule expressed on mesangial cells. An injection of this antibody into rats resulted in mesangial cell-specific injury within 15 min, and induced mesangial proliferative glomerulonephritis in a reproducible manner. We examined the role of mesangial cells in glomerular function using several experimental tools, including an E30-induced nephritis model, mesangial cell culture, and the deletion of specific genes. Herein, we describe the characterization of E30-induced nephritis, formation of the glomerular capillary network, mesangial matrix turnover, and intercellular signaling between glomerular cells. New molecules that are involved in a wide variety of mesangial cell functions are also introduced.

  12. Low birth weight influences glomerular filtration rate:a meta analysis%低出生体重影响肾小球滤过率的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    许戎; 左力; 王海燕

    2008-01-01

    目的 研究比较低出生体重对肾小球滤过率的远期影响.方法 以"birth weight"、"creatinine clearance"、"glomerular filtration rate"、"renal function"对Pubmed所有文献进行检索.按筛选标准共有7篇文献入选.使用Revman4.2进行统计分析.结果 低出生体重者肾小球滤过率较低,约比正常出生体重者降低4ml/(min·1.73m2),剔除以儿童为观察对象的研究后,结果 仍显示低出生体重者肾小球滤过率较低,约比正常出生体重者降低3~4ml/(min·1.73m2).结论 低出生体重者要儿童期以后虽然肾小球滤过率在正常范围,但已比正常出生体重者有降低.

  13. Glomerular ultrafiltration of IGF-I may contribute to increased renal sodium retention in diabetic nephropathy.

    Science.gov (United States)

    Wang, S N; Lapage, J; Hirschberg, R

    1999-08-01

    Insulin-like growth factor-I (IGF-I) is found in plasma at relatively high levels (approximately 40 nmol/L) but 99% is bound to specific binding proteins to form high-molecular-weight complexes of approximately 50 and approximately 150 kd. We hypothesized that in rats with diabetic nephropathy but not in normal animals, IGF-I-containing binding protein complexes undergo glomerular ultrafiltration, allowing the peptide to interact with IGF-I receptors in apical tubular membranes. By this route, ultrafiltered IGF-I may increase tubular epithelial cell sodium absorption in overt diabetic nephropathy. In serum samples from diabetic rats, IGF-I levels (227 +/- 34 ng/mL) were reduced as compared with control levels (319 +/- 33 ng/mL, P = .05), and IGF-binding protein-2 (IGFBP-2) is increased about 2-fold. In diabetic rats, IGF-I undergoes glomerular ultrafiltration and is present in proximal tubular fluid that was collected by nephron micropuncture at 2.54 +/- 0.54 nmol/L but is below the detection limit in tubular fluid from normal rats. IGFBP-1, IGFBP-2, IGFBP-3, and IGFBP-4 are all present in diabetic rat glomerular ultrafiltrate, but IGFBP-2 levels are greater than those of each of the other three IGFBPs. Neither recombinant human IGF-I (1 nmol/L) nor diabetic rat glomerular ultrafiltrate affect sodium transport in cultured mouse proximal tubular cells. In contrast, rhIGF-I and diabetic rat glomerular ultrafiltrate increase the apical-to-basolateral transport of 22Na+ in distal tubule-like A6 cells through mechanisms involving apical IGF-I receptors. In normal rats, luminal infusion with rhIGF-I or with diabetic rat glomerular ultrafiltrate into late proximal tubules increases distal tubular Na+ absorption. These findings indicate that diabetic glomerular sclerosis causes glomerular ultrafiltration of IGF-I, and they suggest that tubular fluid IGF-I may contribute to sodium (and fluid) retention that is commonly observed in patients with severe diabetic nephropathy.

  14. Myocardial infarction worsens glomerular injury and microalbuminuria in rats with pre-existing renal impairment accompanied by the activation of ER stress and inflammation.

    Science.gov (United States)

    Dong, Zhifeng; Wu, Penglong; Li, Yongguang; Shen, Yuan; Xin, Ping; Li, Shuai; Wang, Zhihua; Dai, Xiaoyan; Zhu, Wei; Wei, Meng

    2014-12-01

    Deterioration of renal function occurs after chronic heart failure in approximately one-third of patients, particularly in those with pre-existing renal impairment such as diabetic nephropathy. Impaired renal function in these patients is always associated with a worse prognosis. However, the mechanisms underlying such deterioration of renal function are still largely unknown. In three separate protocols, we compared 1) sham operation (Ctr, n = 10) with surgically induced myocardial infarction (MI, n = 10); 2) unilateral nephrectomy (UNX, n = 10) with UNX + MI (n = 10); and 3) STZ-induced type 1 diabetes (DB, n = 10) with DB + MI (n = 10). The differences between combined injury models (UNX + MI, DB + MI) and simple MI were also examined. Renal remodeling, function, ER stress (CHOP and GRP78) and inflammation (infiltration of inflammatory cells, NF-κB p65) were evaluated 12 weeks after MI. In common SD rats, MI activated less glomerular ER stress and inflammation, resulting in a minor change of glomerular remodeling and microalbuminuria. However, MI significantly increased the glomerular expression of GRP78 and CHOP in UNX and DB rats. In addition, it also promoted the infiltration of CD4+ T cells, particularly inflammatory cytokine (IFN-γ, IL-17, IL-4)-producing CD4+ T cells, and the expression of NF-κB p65 in the glomeruli. By contrast, significant glomerular fibrosis, glomerulosclerosis, podocyte injury and microalbuminuria were found in rats with UNX + MI and DB + MI. MI significantly increased chronic glomerular injury and microalbuminuria at 12 weeks in rats with pre-existing renal impairment, i.e., UNX and DB, but not common SD rats. These changes were accompanied by increased glomerular ER stress and immune-associated inflammation.

  15. Determination of glomerular filtration rate in patients with early diabetic nephropathy%早期糖尿病肾病患者肾小球滤过率测定

    Institute of Scientific and Technical Information of China (English)

    朱巧红

    2015-01-01

    Objective To investigate the effect of the determination of glomerular filtration rate in treatment of early diabetic nephropathy.Methods Patients with early diabetic nephropathy and normal in our hospital from January 2012 to January 2014 were selected as a medical study,and divided into an early diabetes group and a normal group,30 cases in each group.The glomerular filtration rate between the two groups were determined and compared. Results GFR average index in normal albuminuria group and microalbuminuria group was higher than that in normal group, and difference in the two group compared with the normal group was significant (P<0.05);A large number of albuminuria GFR index was lower than that in the normal group,with significant difference (P<0.05);With UAER,diabetic patients with elevated BUN,Cr,and only a large number of albuminuria group of patients with BUN,Cr significant difference compared with the normal group (P<0.05). Conclusion Using the determination of glomerular filtration rate for early check in diabetic patients,the result can accurately reflect the status of early diabetic nephropathy in patients with renal damage,so as to provide reference for clinical treatment,is worthy of clinical application.%目的:探讨肾小球滤过率测定对早期糖尿病肾病患者治疗的作用。方法选取2012年1月~2014年1月我院收治的早期糖尿病肾病患者以及在此期间来我院进行体检的正常人为研究对象。分为早期糖尿病组与正常组,每组各30例;同时对两组进行肾小球滤过率测定,比较两组的肾小球滤过率。结果正常白蛋白尿组、微量白蛋白尿组的GFR高于正常组平均指标,且两者与正常组相比差异有统计学意义(P<0.05);大量白蛋白尿组的GFR指标低于正常组,两者相比差异有统计学意义(P<0.05);随UAER的增多,糖尿病患者的BUN、Cr升高,且只有大量白蛋白尿组患者的BUN、Cr与正常组相比

  16. Effects of pitavastatin (LIVALO tablet) on the estimated glomerular filtration rate (eGFR) in hypercholesterolemic patients with chronic kidney disease. Sub-analysis of the LIVALO Effectiveness and Safety (LIVES) Study.

    Science.gov (United States)

    Kimura, Kenjiro; Shimano, Hitoshi; Yokote, Koutaro; Urashima, Mitsuyoshi; Teramoto, Tamio

    2010-06-30

    In addition to the risk of progression to end-stage renal disease (ESRD), chronic kidney disease (CKD) is also known to be associated with an elevated risk of cardiovascular disease (CVD). Statins may improve renal function in CKD patients. The database of the LIVALO Effectiveness and Safety (LIVES) Study, a large-scale (n=20,279), long-term (104 weeks), prospective post-marketing surveillance study of hypercholesterolemic patients treated with pitavastatin, was used to evaluate the effects of pitavastatin on the estimated glomerular filtration rate (eGFR). Of the 19,925 patients enrolled in the aforementioned study, data from 3,119 patients were analyzed to evaluate the effects of pitavastatin treatment for 104 weeks on the eGFR. In this subanalysis, 958 patients with a baseline eGFR of less than 60 mL/min/1.73 m(2) (30.7%) were analyzed. A significant increase of the eGFR (+5.4 mL/min/1.73 m(2)) was observed after 104 weeks of pitavastain treatment (p analysis of the time-course of changes in the eGFR in response to pitavastatin treatment, the eGFR was elevated by 2.4 mL/min/1.73 m(2) after 12 weeks' treatment, and by 5.6 mL/min/1.73 m(2) after 104 weeks' treatment (p multivariate analysis identified the presence/absence of proteinuria and the amount change of HDL-C as clinical factors associated with increased eGFR during pitavastatin treatment. Increased eGFR was noted after 104 weeks of treatment with pitavastatin, which suggests a possible effect of the statin on CKD.

  17. Tissue transglutaminase inhibition as treatment for diabetic glomerular scarring: it's good to be glueless.

    Science.gov (United States)

    Schelling, Jeffrey R

    2009-08-01

    Diabetic nephropathy is characterized by enhanced glomerular and tubulointerstitial deposition of extracellular matrix proteins, which are bound together by tissue transglutaminase (TG2). Huang et al. demonstrate that infusion of a novel TG2 inhibitor in diabetic rats prevented renal scarring and albuminuria and preserved glomerular filtration rate. These studies confirm the role of TG2 in the pathogenesis of diabetic nephropathy and add to an emerging literature that demonstrates that TG2 is an attractive therapeutic target for sclerosing kidney diseases.

  18. Renal vascular effects of calcium channel blockers in hypertension.

    Science.gov (United States)

    Benstein, J A; Dworkin, L D

    1990-12-01

    Recent evidence suggests that calcium channel blockers have specific effects on renal hemodynamics in patients with hypertension and may also slow the progression of chronic renal failure. When these agents are studied in vitro, their predominant effect is to reverse afferent arteriolar vasoconstriction induced by catecholamines or angiotensin II. Because efferent resistance may remain high, glomerular filtration rate rises while renal blood flow remains low. The effects in vivo are less consistent. In human hypertension, calcium channel blockers lower renal resistance and may raise both renal blood flow and glomerular filtration rate. In experimental models of chronic renal disease, calcium channel blockers slow the progression of renal damage; however, variable effects on renal hemodynamics have been found. Other factors implicated in the progression of renal damage, including compensatory renal hypertrophy, platelet aggregation, and calcium deposition, may also be favorably influenced by these agents. Recent studies suggest that calcium channel blockers may have similar protective effects in patients with hypertension and chronic renal disease.

  19. Measurement of the ratio of glomerular filtration rate to plasma volume from the technetium-99m diethylene triamine pentaacetic acid renogram: comparison with glomerular filtration rate in relation to extracellular fluid volume

    Energy Technology Data Exchange (ETDEWEB)

    Peters, A.M. (Dept. of Diagnostic Radiology, Hammersmith Hospital, London (United Kingdom)); Allison, H. (Dept. of Diagnostic Radiology, Hammersmith Hospital, London (United Kingdom)); Ussov, W.Yu. (Dept. of Diagnostic Radiology, Hammersmith Hospital, London (United Kingdom))

    1994-04-01

    We describe a technique which does not require a blood sample, is already normalised for plasma volume and uses the robust Patlak plot for measuring renal uptake. The rate of kidney uptake, dR(t)/dt, at time = 0, as a fraction of the injected dose, is equal to the fraction of the plasma volume (PV) filtered per minute, i.e. IKGFR/PV. The gradient dR(0)/dt cannot be accurately measured directly but is equal to [[alpha] . LV(0)], where [alpha] is the renal uptake constant (proportional to IKGFR) and LV is the count rate over a left ventricular ROI. LV(0) was obtained by extrapolation of LV(t), while [alpha] is the slope of the Patlak plot up to 3 min. GFR/PV (i.e. right plus left kidneys) in patients with normal renal function was about 0.04 min[sup -1], as would be expected from normal values of GFR (120 ml/min) and plasma volume (3 l). GFR/PV correlated significantly with the ratio of GFR to extracellular fluid volume (ECV), measured from the terminal exponential of the plasma clearance curve (GFR/PV = 3.2.GFR/ECV + 5.3 ml/min/l [r = 0.82, n = 82]). GFR/PV (r = 0.74) and GFR/ECV (r = 0.82) both correlated inversely and non-linearly with plasma creatinine in 43 studies where the measurement was made within 1 week of the [sup 99m]Tc-DTPA study. They also correlated significantly with the plasma cyclosporin trough level in 14 patients with dermatomyositis on the 30 occasions when this measurement was made within 1 week of the renogram (r = -0.38, P < 0.05 for GFR/PV and r = -0.77, P < 0.001 for GFR/ECV). The ratio of GFR/PV to GFR/ECV is the ratio of extracellular fluid volume to plasma volume, and this was 4.0 (SD 0.99). We conclude that both GFR/PV and GFR/ECV can be easily measured with [sup 99m]Tc-DTPA and are physiologically valid expressions of GFR. (orig./MG)

  20. 酶法检测肌酐值估算的肾小球滤过率分析%Estimation of Glomerular Filtration Rate with Enzymatic-assayed Serum Creatinine Values

    Institute of Scientific and Technical Information of China (English)

    傅辰生; 冯欣慧; 张晓丽; 严震文; 叶志斌

    2012-01-01

    目的:通过重新表达的MDRD公式(reexpressed modification of diet in renal disease study equation,rMDRD公式),以酶法检测肌酐值估测肾小球滤过率(glomerular filtration rate,GFR),分析rMDRD公式应用于中国慢性肾脏病(chronic kidney disease,CKD)患者所得估算的GFR(estimated GFR,eGFR)的精确度及准确性.方法:回顾分析893例CKD患者的临床资料,以同位素法测定的GFR为标准,分析酶法检测肌酐值代入rMDRD公式所得eGFR的精确度及准确性,并评价适当数据转换是否可以提高该公式应用于中国CKD患者的效能.结果:rMDRD公式直接应用于中国CKD患者时精确度和准确性均较低,进行数据转换后,估测效能有所提高,但仍显著低于西方人群.结论:rMDRD公式不适合直接应用于中国CKD患者,亟待开发基于酶法检测肌酐值的eGFR公式.%Objective:To evaluate the performance of the rccxprcsscd modification of diet in renal disease (rMDRD) study equation in estimating giomcruiar filtration rate (cGFR) from enzymatic-assayed scrum crcatininc values in Chinese chronic kidney disease (CKD) patients. Methods: Data of 893 Chinese CKD patients were retrospectively collected. The cGFR estimated by rMDRD equation with enzymatic-assayed scrum crcatininc values in these patients were analyzed, with GFR obtained by isotope scanning as standard. Data transformation was done to improve the performance of the equation. Results: The performance of rMDRD equation in Chinese CKD patients was not satisfying, even if the data was transformed. Conclusions: The rMDRD equation is not good enough for Chinese CKD patients. It is expected to explore an cGFR equation suitable for Chinese CKD patients with enzymatic-assayed scrum crcatininc values.

  1. Plasma NGAL and glomerular filtration rate in cardiac transplant recipients treated with standard or reduced calcineurin inhibitor levels

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Gude, Einar; Sigurdardottir, Vilborg

    2014-01-01

    GFR) at baseline (R(2) = 0.21; p year (median [25-75 % percentiles]: ΔmGFR 5.5 [-0.5-11.5] vs -1 [-7-4] ml/min/1.73 m(2); p = 0.006). Baseline P-NGAL predicted mGFR after 1 year (R(2) = 0.18; p ...: P-NGAL was measured in 88 cardiac transplantation patients (median 5 years post-transplant) with renal dysfunction randomized to continuation of conventional calcineurin inhibitor-based immunosuppression or switching to an everolimus-based regimen. RESULTS: P-NGAL correlated with measured GFR (m...

  2. Expression and response to angiotensin-converting enzyme inhibition of matrix metalloproteinases 2 and 9 in renal glomerular damage in young transgenic rats with renin-dependent hypertension

    NARCIS (Netherlands)

    Bolbrinker, J; Markovic, S; Wehland, M; Melenhorst, WBWH; van Goor, H; Kreutz, R

    Extracellular matrix expansion in the glomerular mesangium contributes to the development of glomerulosclerosis and chronic renal disease in arterial hypertension. Transforming growth factor-beta 1 (TGF-beta 1), matrix metalloproteinases (MMPs), and tissue inhibitors of MMPs (TIMPs) are involved in

  3. Elastase, but not proteinase 3 (PR3), induces proteinuria associated with loss of glomerular basement membrane heparan sulphate after in vivo renal perfusion in rats

    NARCIS (Netherlands)

    Heeringa, P; VanDenBorn, J; Brouwer, E; Dolman, KM; Klok, PA; Huitema, MG; Limburg, PC; Bakker, MAH; Berden, JHM; Daha, MR; Kallenberg, CGM

    1996-01-01

    Elastase, but not PR3, induces proteinuria associated with loss of glomerular basement membrane (GEM) heparan sulphate after in vivo renal perfusion in rats. PR3 and elastase are cationic neutral serine proteinases present in the azurophilic granules of polymorphonuclear leucocytes. Release of these

  4. Preimplantation biopsy predicts delayed graft function, glomerular filtration rate and long-term graft survival of transplanted kidneys

    Directory of Open Access Journals (Sweden)

    José A. Pedroso

    2016-01-01

    Full Text Available The predictive value of preimplantation biopsies for long-term graft function is often limited by conflicting results. The aim of this study was to evaluate the influence of time-zero graft biopsy histological scores on early and late graft function, graft survival and patient survival, at different time points. We retrospectively analyzed 284 preimplantation biopsies at a single center, in a cohort of recipients with grafts from live and deceased donors (standard and nonstandard, and their impact in posttransplant renal function after a mean follow-up of 7 years (range 1-16. Implantation biopsy score (IBS, a combination score derived from 4 histopathological aspects, was determined from each sample. The correlation with incidence of delayed graft function (DGF, creatinine clearance (1st, 3rd and 5th posttransplant year and graft and patient survival at 1 and 5 years were evaluated. Preimplantation biopsies provided somewhat of a prognostic index of early function and outcome of the transplanted kidney in the short and long term. In the immediate posttransplantation period, the degree of arteriolosclerosis and interstitial fibrosis correlated better with the presence of DGF. IBS values between 4 and 6 were predictive of worst renal function at 1st and 3rd years posttransplant and 5-year graft survival. The most important histological finding, in effectively transplanted grafts, was the grade of interstitial fibrosis. Patient survival was not influenced by IBS. Higher preimplantation biopsy scores predicted an increased risk of early graft losses, especially primary nonfunction. Graft survival (at 1st and 5th years after transplant but not patient survival was predicted by IBS.

  5. Gender-specific association of decreased estimated glomerular filtration rate and left vertical geometry in the general population from rural Northeast China.

    Science.gov (United States)

    Dai, Dongxue; Chang, Ye; Chen, Yintao; Yu, Shasha; Guo, Xiaofan; Sun, Yingxian

    2017-01-13

    Left ventricular hypertrophy (LVH) is common and associated with cardiovascular outcomes among patients with known chronic kidney disease (CKD). However, the link between decreased estimated glomerular filtration rate (eGFR) and left ventricular (LV) geometry remains poorly explored in general population. In this study, we examined the gender-specific association between eGFR and LVH in the general population from rural Northeast China. This survey was conducted from July 2012 to August 2013. A total of 10907 participants (5,013 men and 5,894 women) from the rural Northeast China were randomly selected and examined. LV mass index (LVMI) was used to define LVH (LVMI > 46.7 g/m(2.7) in women; > 49.2 g/m(2.7) in men). LV geometry was defined as normal, or with concentric remodeling, eccentric or concentric hypertrophy, according to relative wall thickness (RWT) and LVMI. Mildly decreased eGFR was defined as eGFR ≥ 60 and geometry. Only in men, mildly decreased eGFR was associated with concentric remodeling [odds ratio (OR): =1.58; 95% CI: 1.14-2.20; P geometry in men, and a gender-specific difference should be taken into account in clinical practice.

  6. Self-reported sleep duration is associated with reduced glomerular filtration rate among adults with hypertension: a population-based study from rural northeast China.

    Science.gov (United States)

    Guo, Xiaofan; Yu, Shasha; Li, Zhao; Guo, Liang; Zheng, Liqiang; Yang, Hongmei; Zou, Lu; Hu, Wenyu; Zhou, Ying; Zhu, Luoning; Zhang, Yonghong; Sun, Yingxian

    2015-06-01

    Short sleep duration has been found recently to be a predictor of proteinuria. However, population-based investigations addressing the association between self-reported sleep duration and glomerular filtration rate (GFR) among hypertensive patients are lacking. We therefore sought to investigate the extent to which self-reported sleep duration might be associated with reduced GFR in a large hypertensive population in rural northeast China. A total of 5555 hypertensive participants, aged ≥35 years, in rural areas of Liaoning Province, China, were screened between January 2012 and August 2013, using a stratified, cluster multi-stage sampling scheme. Anthropometric measurements, self-reported sleep duration, blood biochemical indexes and other health-related variables were collected by medically trained personnel. Reduced GFR was defined as the estimated GFR (eGFR) 7 and ≤8 h day(-1) ). We concluded that short self-reported sleep duration (≤6 h per night) was related significantly to an increased risk of reduced GFR in a hypertensive population. This novel risk factor should be taken into consideration during daily management of hypertension to prevent chronic kidney disease.

  7. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy.

    Science.gov (United States)

    Goraya, Nimrit; Simoni, Jan; Jo, Chanhee; Wesson, Donald E

    2012-01-01

    The neutralization of dietary acid with sodium bicarbonate decreases kidney injury and slows the decline of the glomerular filtration rate (GFR) in animals and patients with chronic kidney disease. The sodium intake, however, could be problematic in patients with reduced GFR. As alkali-induced dietary protein decreased kidney injury in animals, we compared the efficacy of alkali-inducing fruits and vegetables with oral sodium bicarbonate to diminish kidney injury in patients with hypertensive nephropathy at stage 1 or 2 estimated GFR. All patients were evaluated 30 days after no intervention; daily oral sodium bicarbonate; or fruits and vegetables in amounts calculated to reduce dietary acid by half. All patients had 6 months of antihypertensive control by angiotensin-converting enzyme inhibition before and during these studies, and otherwise ate ad lib. Indices of kidney injury were not changed in the stage 1 group. By contrast, each treatment of stage 2 patients decreased urinary albumin, N-acetyl β-D-glucosaminidase, and transforming growth factor β from the controls to a similar extent. Thus, a reduction in dietary acid decreased kidney injury in patients with moderately reduced eGFR due to hypertensive nephropathy and that with fruits and vegetables was comparable to sodium bicarbonate. Fruits and vegetables appear to be an effective kidney protective adjunct to blood pressure reduction and angiotensin-converting enzyme inhibition in hypertensive and possibly other nephropathies.

  8. The Beneficial Role of Retinoids in Glomerular Disease

    Directory of Open Access Journals (Sweden)

    Sandeep eMallipattu

    2015-03-01

    Full Text Available The primary etiology of CKD is a direct consequence of initial dysfunction and injury of the glomerulus, the main filtration system. Podocytes are terminally differentiated epithelial cells in the glomerulus, whose major function is the maintenance of this renal filtration barrier. Podocyte injury is implicated in many glomerular diseases including Focal Segmental Glomerular Sclerosis (FSGS and HIV-associated nephropathy (HIVAN. In many of these diseased conditions, the podocyte can either undergo dedifferentiation and proliferation, apoptosis, or cell detachment. Regardless of the initial type of injury, the podocyte ultimately loses its functional capacity to maintain the glomerular filtration barrier. Significant injury resulting in a loss of the podocytes and failure to maintain the renal filtration barrier contributes to progressive kidney disease. Consequently, therapies that prevent podocyte injury and promote their regeneration will have a major clinical impact on glomerular disease. Retinoic acid (RA, which is a derivative of vitamin A, has many cellular functions including induction of cell differentiation, regulation of apoptosis, and inhibition of inflammation and proliferation. RA is required for kidney development and is essential for cellular differentiation in the setting of podocyte injury. The mechanism by which RA directs its beneficial effects is multifactorial, ranging from its anti-inflammatory and anti-fibrotic effects to a direct effect of upregulating podocyte differentiation markers in the podocyte. The focus of this review is to provide an overview of RA in kidney development and glomerular disease. We also highlight the key mechanism(s by which RA restores podocyte differentiation markers and ameliorates glomerular disease.

  9. The prognostic value of estimated glomerular filtration rate, amino-terminal portion of the pro-hormone B-type natriuretic peptide and parameters of cardiopulmonary exercise testing in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    G.Aernout Somsen

    2012-06-01

    Full Text Available The aim of this study was to evaluate the prognostic value of renal function in relation to amino-terminal portion of the pro-hormone B-type natriuretic peptide (NT-proBNP and parameters of cardiopulmonary exercise testing in predicting mortality and morbidity in patients with moderate chronic heart failure (CHF. Sixty-one CHF patients were included in the study. Patients’ characteristics were: age 64.3±11.6 years; New York Heart Association class I/II/III: 14/37/10; left ventricular ejection fraction: 0.30±0.13 (%; NT-proBNP: 252.2±348.0 (ng/L; estimated creatinine clearance (e-CC: 73.6±31.4 (mL/min; estimated glomerular filtration rate (e-GFR: 66.1±24.6 (mL/min/1.73 m2; the highest O2 uptake during exercise (VO2-peak: 1.24±0.12 mL/kg/min; VO2/workload: 8.52±1.81 (mL/min/W]. During follow up (59.5±4.0 months there were 15 cardiac deaths and 16 patients were hospitalized due to progression of heart failure. NT-proBNP and VO2/workload were independently associated with cardiac death (P=0.007 and P=0.006, respectively. Hospitalization for progressive CHF was only associated with NT-proBNP (P=0.002. The combined cardiac events (cardiac death and hospitalization were associated with NT-proBNP and VO2/workload (P=0.007 and P=0.005, respectively. The addition of estimates of renal function (neither serum creatinine nor e-GFR did not improve the prognostic value for any of the models. In conclusion, in patients with moderate CHF, increased NT-proBNP and reduced VO2/workload identify those with increased mortality and morbidity, irrespective of estimates of renal function.

  10. The prognostic value of estimated glomerular filtration rate, amino-terminal portion of the pro-hormone B-type natriuretic peptide and parameters of cardiopulmonary exercise testing in patients with chronic heart failure.

    Science.gov (United States)

    Verberne, Hein J; van der Spank, Aukje; Bresser, Paul; Somsen, G Aernout

    2012-06-05

    The aim of this study was to evaluate the prognostic value of renal function in relation to amino-terminal portion of the pro-hormone B-type natriuretic peptide (NT-proBNP) and parameters of cardiopulmonary exercise testing in predicting mortality and morbidity in patients with moderate chronic heart failure (CHF). Sixty-one CHF patients were included in the study. Patients' characteristics were: age 64.3±11.6 years; New York Heart Association class I/II/III: 14/37/10; left ventricular ejection fraction: 0.30±0.13 (%); NT-proBNP: 252.2±348.0 (ng/L); estimated creatinine clearance (e-CC): 73.6±31.4 (mL/min); estimated glomerular filtration rate (e-GFR): 66.1±24.6 (mL/min/1.73 m(2)); the highest O2 uptake during exercise (VO(2-peak)): 1.24±0.12 mL/kg/min; VO(2)/workload: 8.52±1.81 (mL/min/W)]. During follow up (59.5±4.0 months) there were 15 cardiac deaths and 16 patients were hospitalized due to progression of heart failure. NT-proBNP and VO(2)/workload were independently associated with cardiac death (P=0.007 and P=0.006, respectively). Hospitalization for progressive CHF was only associated with NT-proBNP (P=0.002). The combined cardiac events (cardiac death and hospitalization) were associated with NT-proBNP and VO(2)/ workload (P=0.007 and P=0.005, respectively). The addition of estimates of renal function (neither serum creatinine nor e-GFR) did not improve the prognostic value for any of the models.In conclusion, in patients with moderate CHF, increased NT-proBNP and reduced VO(2)/ work-load identify those with increased mortality and morbidity, irrespective of estimates of renal function.

  11. Applicability of Cockcroft-Gault and MDRD equations to estimate the glomerular filtration rates%肾小球滤过率评估公式的适用性

    Institute of Scientific and Technical Information of China (English)

    潘瑞蓉; 袁国跃; 叶菁菁; 杨玲; 王东; 王济芳; 陈霞; 王莹; 孙新艳; 马秋芳

    2011-01-01

    Objective; To investigate the application of Cockcroft-Gault(C-G) and simplified MDRD e-quations in estimating the glomerular filtration rates(GFR) in different stage renal disease. Methods; A total of 143 cases with primary or secondary chronic kidney disease were enrolled in this study. GFR by 99mTc-DTPA clearance rate was used as the reference standard. The patients were divided into four subgroups according to the GFR obtained from Gates. Group A,30 cases, GFR≥90 ml/min;group B,36 cases, 60 ml/min≤ GFR 0.05) ,rB =0.742(P 0. 05 ). The GFR [ ml · min-1· (1. 73m2) -1 ] obtained from Gates methods and MDRD equations: the correlation coefficients of four subgroups were as follows: rA=0.024 (P>0.05) ,rB=0.674 (P 0. 05). Conclusion: Cockcroft-Gault (C-G) and simplified MDRD equations were more suitable for patients with chronic kidney disease in 2,3 stage, by contrast, accuracy of CG formula was slightly better than the MDRD formula in Han nationality. Further research is needed for renal function estimation formulas in Chinese Han population.%目的:以99mTc-DTPA 同位素测定的肾小球滤过率(glomerular filtration rate,GFR)为参考标准,评估美国肾脏病基金会推荐的Cockcroft-Gault(C-G)公式与简化MDRD公式对肾功能进行分期的适用性.方法:以143 例慢性肾脏病患者为研究对象,采用肾动态显像99m Tc标记法测定GFR,根据慢性肾脏病的分期标准,将患者分成4组:A组30例,GFR≥90 ml/min;B组36例,60 ml/min≤GFR<90 ml/min;C组47例,30 ml/min≤GFR<60 ml/min;D组30例GFR<30 ml/min.对各组患者分别采用CG公式、简化MDRD公式估算GFR值并用体表面积(BSA)标准化,分别与不同组BSA标准化的99mTc- DTPA 测得GFR进行比较,并进行相关性分析,评价估算公式的准确性.结果:(1) 采用肾动态显像99m Tc标记法测定的GFR与CG公式估算出的4组GFR值[单位:ml·min-1·(1.73m2)- 1]之间的相关系数为rA=-0.166 (P>0.05) ;rB =0.742(P0.05).(2)

  12. Cystatin C相关方程在慢性肾脏病患者的应用评价%Cystatin-C Based Equations for Estimation of Glomerular Filtration Rate in Patients with Chronic Kidney Disease

    Institute of Scientific and Technical Information of China (English)

    李芝帆; 吴小燕; 曾真

    2011-01-01

    Objective: To evaluate the clinical application value of the serum Cystatin-C (Cys C) based equations in calculating glomerular filtration rate (GFR) for patients with chronic kidney disease.Methods: A total of 179 patients with chronic kidney disease were selected, and patients' glomerular filtration rate (GFR) was calculated with MDRD equation, simplified MDRD equation, Hock equation and equations(c-cGFR1, c-cGFR2) recommended by Chinese Society of Nephrology in 2006. These values were compared with the GFR value measured by 99mTc-DTPA renal dynamic imaging examination(sGFR). Results: The results of GFR calculated by the different equations and sGFR were significantly positively correlated, moreover, the results of c-c GFR2 had a higher correlation. Bland-Airman analysis shows that the results of simplified MDRD equation had the highest consistency. Conclusion: Cystatin C as a variable markers of GFR calculated using the second equation recommended by Chinese Soctely of Nephrology in 2006(c-cGFR2) has a higher correlation and consistency with GFR measured by 99mTc-DTPA renal dynamic imaging examination. It can be used to calculate GFR clinically in patients with chronic kidney disease.%目的:评价血清半胱氨酸蛋白酶抑制剂-C(Cys C)相关方程在慢性肾脏病(CKD)患者肾小球滤过率(GFR)计算中的临床应用价值.方法:选取179例慢性肾脏病患者,运用MDRD方程、MDRD简化方程、Hoek方程、2006年中华医学会肾脏病学分会推荐的两个方程计算GFR,与99mTc-DTPA肾动态显像测得的GFR相比较.结果:各方程估算的GFR和99mTc-DTPA肾动态显像测得的GFR均呈相关,其中2006年中华医学会推荐方程2计算的GFR与99mTc-DTPA肾动态显像测得的GFR相关性最好.Bland-Altman分析显示MDRD简化方程计算的GFR和99mTc-DTPA肾动态显像测得的GFR一致性最好.结论:在Cys C相关方程中,2006年中华医学会肾脏病分会推荐公式2计算的GFR,与99mTc-DTPA肾动态显像测

  13. Assessment of Glomerular Filtration Rate Based on Alterations of Serum Brain-Derived Neurotrophic Factor in Type 2 Diabetic Subjects Treated with Amlodipine/Benazepril or Valsartan/Hydrochlorothiazide

    OpenAIRE

    I-Te Lee; Wayne Huey-Herng Sheu; Yi-Jen Hung; Jung-Fu Chen; Chih-Yuan Wang; Wen-Jane Lee

    2015-01-01

    Background. Brain-derived neurotrophic factor (BDNF) is associated with sympathetic activation. However, the effects of BDNF on diabetic nephropathy are unknown. The aim of this study was to assess the estimated glomerular filtration rates (eGFRs) and changes in serum BDNF levels in type 2 diabetic subjects treated with antihypertensive medications. Methods. In this randomized, double-blind clinical trial, type 2 diabetic subjects with hypertension were assigned to either the benazepril/amlod...

  14. Relationships of pancreatic beta-cell function with microalbuminuria and glomerular filtration rate in middle-aged and elderly population without type 2 diabetes mellitus: a Chinese community-based analysis

    Science.gov (United States)

    Fu, Shihui; Zhou, Shanjing; Luo, Leiming; Ye, Ping

    2017-01-01

    Background Relationships of pancreatic beta-cell function abnormality with microalbuminuria (MA) and glomerular filtration rate (GFR) may differ by age, ethnicity and accompanied diseases. Previous studies were generally conducted in Western adult patients with type 2 diabetes mellitus (T2DM), and it is uncertain whether pancreatic beta-cell function is associated with MA and GFR in Chinese community-dwelling middle-aged and elderly population without T2DM. We therefore examined the relationships of pancreatic beta-cell function with two indices of renal damage, MA and GFR, in Chinese community-dwelling middle-aged and elderly population without T2DM. Methods This analysis focused on 380 Beijing residents older than 45 years who were free of T2DM and completed the evaluation of pancreatic beta-cell function. Results Median age was 67 (49–80) years. Levels of triglyceride, diastolic blood pressure and homeostasis model assessment-beta (HOMA-beta) index were positively related to urine microalbumin (P0.05 for all). Conclusion Modeling the pancreatic beta-cell function with different adjusted variables provided the same conclusion of association with MA; beta-cell function was positively associated with MA. Additionally, there was a specific difference in the adjusted associations of pancreatic beta-cell function with MA and GFR <60 mL/min/1.73 m2; beta-cell function was not independently associated with GFR <60 mL/min/1.73 m2. This result indicated that abnormal pancreatic beta-cell function plays an important role in the development of MA. PMID:28496313

  15. Impact of interobserver variation in region-of-interest drawing on the measurement of glomerular filtration rates with Gates' method%不同操作者对Gates法测定肾小球滤过率的影响

    Institute of Scientific and Technical Information of China (English)

    艾虎; 张建飞; 孙福成; 姚稚明; 郑建国

    2011-01-01

    Objective To investigate the influence of different region-of-interest (ROI) drawing on the measurement of glomerular filtration rate (GFR) with Gates' method.Methods Dynamic renal imaging was performed in 55 patients.GFR was calculated from different ROI drawed by two different observers and was compared by using linear regression analysis.Results No significant difference was observed in GFR obtained from two observers(49.94 ± 18.81 vs.49.78 ± 18.48,P >0.05).The correlation coefficient of GFR from 2 observers was 0.961 (P<0.01 ).Conclusion The measurement of GFR in Gates'method displays good interobserver reproducibility.%目的 探讨不同操作者进行勾划设置感兴趣区对Gates法测定肾小球滤过率的影响.方法 对55例患者行肾动态显像,2位勾划者设置感兴趣区并得出肾动态显像测定肾小球滤过率(GFR).比较2次勾划所得GFR的相关性.结果 2次勾划所得GFR差异无统计学意义(49.94±18.81比49.78±18.48,P>0.05),相关系数为0.961(P<0.01).结论 Gates法测定肾小球滤过率有较好的重复性,受勾划者影响较小.

  16. Estimating glomerular filtration rate in oncology patients receiving Cisplatin chemotherapy: Predicted creatinine clearance against 99mTc-DTPA methods

    Science.gov (United States)

    Khaidah Syed Sahab, Sharifah; Manap, Mahayuddin; Hamzah, Fadzilah

    2017-05-01

    The therapeutic potential of cisplatin as the best anticancer treatment for solid tumor is limited by its potential nephrotoxicity. This study analyses the incidence of cisplatin induced nephrotoxicity in oncology patients through GFR estimation using 99mTc-DTPA plasma sampling (reference method) and to compare with predicted creatinine clearance and Tc-99m renal scintigraphy. A prospective study of 33 oncology patients referred for GFR estimation in Penang Hospital. The incidence of cisplatin induced nephrotoxicity was analysed via radionuclide and creatinine based method. Of 33 samples, only 21 selected for the study. The dose of cisplatin given was 75 mg/m2 for each cycle. The mean difference of GFR pre and post chemotherapy (PSC 2) was 13.38 (-4.60, 31.36) ml/min/1.73m2 (p 0.136). Of 21 patients, 3 developed severe nephrotoxicity (GFR < 50ml/min/1.73 m2) contributing 14.3% of incidence. Bland-Altman plot showed only PSC 1 is in agreement with PSC 2 technique. Intraclass Correlation Coefficients (ICC) also showed that PSC 1 has high degree of reliability in comparison to PSC 2 (p < 0.001). The other methods do not show reliability and agreement in comparison to PSC 2 (p < 0.05). 3 of 21 patients (14.3%) developed severe nephrotoxicity post cisplatin chemotherapy. This percentage is much less than the reported 20 - 25% of cases from other studies, probably due to small sample size and biased study population due to strict exclusion criteria. Radionuclide method for evaluating GFR is the most sensitive method for the detection of cisplatin induced nephrotoxicity by showing 3 of 21 patients developing severe nephrotoxicity. PSC 1 was found to be a reliable substitute of PSC 2. The other methods are not reliable for detection of early nephrotoxicity. We will recommend the use of single plasma sampling method (PSC 1) for GFR estimation in monitoring post cisplatin chemotherapy patients.

  17. 肾小球滤过率的标准化参数%The variables in normalizing glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    李飞; 司宏伟; 耿建华; 陈盛祖

    2013-01-01

    GFR的标准化对非肿瘤患者,特别是肾供体较为重要.目前研究较多的GFR标准化参数有:体表面积(BSA)、细胞外液容积(ECV)和瘦体质量(LBM).BSA的准确测定较为困难,且儿童和肥胖者的标准化效能较差;ECV特别适用于健康儿童的标准化,但肾功能受损患者的临床应用价值明显减低;LBM兼具定量准确、适用范围广等优点,现有研究表明其比BSA和ECV更适用于GFR的标准化,但其影响因素尚待进一步深入研究.%Normalizing GFR with variables is important for non-cancer patients,especially for kidney donors.The most frequently evaluated variables are body surface area (BSA),extracellular fluid volume (ECV) and lean body mass (LBM).It is difficult to accurately quantify BSA and the power of BSA normalization decreases in children and obesity population.The ECV normalization is suitable for healthy children,but its clinical value decreases in patients with damaged renal function.The LBM can be accurately measured and has a larger serviceable range in the normalization.Although the influence factors of LBM should be extensively evaluated,the available data indicate that LBM is more suitable in the normalization of GFR than BSA and ECV.

  18. Haematuria as a risk factor for chronic kidney disease progression in glomerular diseases: A review.

    Science.gov (United States)

    Moreno, Juan Antonio; Yuste, Claudia; Gutiérrez, Eduardo; Sevillano, Ángel M; Rubio-Navarro, Alfonso; Amaro-Villalobos, Juan Manuel; Praga, Manuel; Egido, Jesús

    2016-04-01

    Haematuria has long been considered to be a benign condition associated with glomerular diseases. However, new evidences suggest that haematuria has a pathogenic role in promoting kidney disease progression. An increased risk for end-stage renal disease has been reported in adolescents and young adults with persistent microscopic haematuria. A persistent impairment of renal function has been also reported following macroscopic haematuria-associated acute kidney injury in immunoglobulin A nephropathy. Haematuria-induced renal damage has been related to oxidant, cytotoxic and inflammatory effects induced by haemoglobin or haem released from red blood cells. The pathophysiological origin of haematuria may be due to a more fragile and easily ruptured glomerular filtration barrier, as reported in several glomerular diseases. In this review we describe a number of the key issues associated with the epidemiology and pathogenesis of haematuria-associated diseases, provide an update of recent knowledge on the role of haematuria on renal function outcome and discuss specific therapeutic approaches in this setting. KEY SUMMARY POINTS: 1. Glomerular haematuria is a common observation in a number of renal diseases that may lead to persistent renal injury. 2. Haematuria in children differs from that in adults in specific aspects, particularly in the frequency of glomerular diseases and renal disease outcome. 3. Regular follow-up of renal function in children with isolated microhaematuria may be recommended.

  19. Effect of increased protein intake on renal acid load and renal hemodynamic responses

    NARCIS (Netherlands)

    Teunissen-Beekman, Karianna F.M.; Dopheide, Janneke; Geleijnse, Marianne; Bakker, Stephan J.L.; Brink, Elizabeth J.; Leeuw, de Peter W.; Baak, van Marleen A.

    2016-01-01

    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were com

  20. Effect of increased protein intake on renal acid load and renal hemodynamic responses

    NARCIS (Netherlands)

    Teunissen-Beekman, Karianna F M; Dopheide, Janneke; Geleijnse, Johanna M; Bakker, Stephan J L; Brink, Elizabeth J; de Leeuw, Peter W; van Baak, Marleen A

    2016-01-01

    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were compar

  1. Activation of SUR2B/Kir6.1-type KATP channels protects glomerular endothelial, mesangial and tubular epithelial cells against oleic acid renal damage

    Institute of Scientific and Technical Information of China (English)

    Ying ZHAO; Hai WANG

    2012-01-01

    Cumulative evidence suggests that renal vascular endothelial injury play an important role in initiating and extending tubular epithelial injury and contribute to the development of ischemic acute renal failure.Our previous studies have demonstrated that iptakalim's endothelium protection is related to activation of SUR2B/Kir6.1 subtype of ATP sensitive potassium channel (KATP) in the endothelium.It has been reported that SUR2B/Kir6.1 channels are widely distributed in the tubular epithelium,glomerular mesangium,and the endothelium and the smooth muscle of blood vessels.Herein,we hypothesized that activating renal KATP channels with iptakalim might have directly neroprotective effects.In this study,glomerular endothelial,mesangial and tubular epithelial cells which are the main cell types to form nephron were exposed to oleic acid (OA) at various concentrations for 24 h.0.25 μl/ml OA could cause cellular damage of glomerular endothelium and mesangium,while 1.25μl/ml OA could lead to the injury of three types of renal cells.It was observed that pretreatment with iptakalim at concentrations of 0.1,1,10 or 100 μmol/L prevented cellular damage of glomerular endothelium and tubular epithelium,whereas iptakalim from 1 to 100 μmol/L prevented the injury of mesangial cells.Our data showed iptakalim significantly increased survived cell rates in a concentration-dependent manner,significantly antagonized by glibenclamide,a KATP blocker.Iptakalim played a protective role in the main cell types of kidney,which was consistent with natakalim,a highly selective SUR2B/Kir6.1 channel opener.Iptakalim exerted protective effects through activating SUR2B/Kir6.1 channels,suggesting a new strategy for renal injury by its endothelial and renal cell protection.

  2. Relationship between Estimated Glomerular Filtration Rate and Cardiovascular Mortality in a Japanese Cohort with Long-Term Follow-Up.

    Directory of Open Access Journals (Sweden)

    Kei Nagai

    Full Text Available Patients with renal impairment are at risk of not only end-stage kidney disease but also cardiovascular disease (CVD. The current definition of CKD stage G3a is eGFR 45-59 ml/min/1.73 m2 and of G3b is 30-44 ml/min/1.73 m2, and subjects in the CKD 3a category are considered to be at lower risk of mortality than are those in CKD 3b.We evaluated the outcome of 97,043 people (33,131 men and 63,912 women living in Ibaraki Prefecture who underwent annual community-based health checkups beginning in 1993 at age 40-80 years and who were followed for a mean of 17.1 years.The number of all-causes deaths was 20,534 (10,375 men and 10,159 women, of which 5,995 (2,695 men and 3,300 women were deaths due to CVD. Multivariable-adjusted hazard ratio for CVD death in the eGFR 45-49 ml/min/1.73 m2 category was significantly increased (1.82; 95% confidential interval, 1.23-2.69 in non-elderly men, whereas all-cause mortality and CVD mortality in elderly men with eGFR 45-49 ml/min/1.73m2 were non significant. In contrast, both in non-elderly women and in elderly women with eGFR 45-49 ml/min/1.73 m2 showed small, but significant, increases in the risks of all-cause mortality and CVD.We demonstrated proportionate increases in mortality with decreasing eGFR in a Japanese CKD population. Like patients in the CKD G3b subgroup, non-elderly men and women with an eGFR of 45-49 ml/min/1.73 m2 (i.e. a part of CKD G3a are at considerable risk of CVD mortality. Age dependent and eGFR dependent finer risk recognition were required for CVD prevention in clinical practice with regard to CKD patients.

  3. Use of cystatin C-based estimations of glomerular filtration rate in patients with type 2 diabetes.

    Science.gov (United States)

    Chudleigh, R A; Ollerton, R L; Dunseath, G; Peter, R; Harvey, J N; Luzio, S; Owens, D R

    2009-07-01

    The Modification of Diet in Renal Disease (MDRD) equation has recognised limitations when using estimated GFR in persons at risk of chronic kidney disease. Equations based on cystatin C provide an alternative method. We compared performance of the MDRD equation with a selection of cystatin C-based formulae for estimation of GFR in normoalbuminuric patients with type 2 diabetes. Estimated GFR was calculated using the MDRD equation and the cystatin C formulae proposed by several investigator teams. Isotopic GFR was measured using plasma clearance of (51)Cr-EDTA. We studied 106 participants, of whom 83 (78%) were men with the following characteristics, mean (SD): age 61 (9) years, HbA(1c) 7.10 (1.27)%, creatinine 89.0 (12.7) micromol/l, cystatin C 0.859 (0.234) mg/l and isotopic GFR 104.5 (20.1) ml min(-1) 1.73 m(-2). MDRD estimated GFR was 77.4 (13.6) ml min(-1) 1.73 m(-2) (p < 0.05 for difference from isotopic GFR). Cystatin C-based calculations of estimated GFR were: Perkins 124.5 (31.8), Rule 90.0 (30.0), Stevens (age) 96.0 (30.4) and Stevens (creatinine) 85.6 (19.0) ml min(-1) 1.73 m(-2) (p < 0.05 for difference with isotopic GFR). For Arnal's, MacIsaac's and Tan's formulae cystatin-C estimated GFR were 101.7 (34.8), 102.1 (27.0) and 101.6 (27.8) ml min(-1) 1.73 m(-2), respectively (p = NS for difference with isotopic GFR). Cystatin C-based formulae were less biased and, with the exception of Perkins' formula, more accurate to within 10% of isotopic GFR than MDRD. Performance of cystatin C equations was superior to MDRD in normoalbuminuric patients with type 2 diabetes. These results support further evaluation of cystatin C for estimation of GFR in persons at risk of chronic kidney disease.

  4. Connexin 40 and ATP-dependent intercellular calcium wave in renal glomerular endothelial cells.

    Science.gov (United States)

    Toma, Ildikó; Bansal, Eric; Meer, Elliott J; Kang, Jung Julie; Vargas, Sarah L; Peti-Peterdi, János

    2008-06-01

    Endothelial intracellular calcium ([Ca(2+)](i)) plays an important role in the function of the juxtaglomerular vasculature. The present studies aimed to identify the existence and molecular elements of an endothelial calcium wave in cultured glomerular endothelial cells (GENC). GENCs on glass coverslips were loaded with Fluo-4/Fura red, and ratiometric [Ca(2+)](i) imaging was performed using fluorescence confocal microscopy. Mechanical stimulation of a single GENC caused a nine-fold increase in [Ca(2+)](i), which propagated from cell to cell throughout the monolayer (7.9 +/- 0.3 microm/s) in a regenerative manner (without decrement of amplitude, kinetics, and speed) over distances >400 microm. Inhibition of voltage-dependent calcium channels with nifedipine had no effect on the above parameters, but the removal of extracellular calcium reduced Delta[Ca(2+)](i) by 50%. Importantly, the gap junction uncoupler alpha-glycyrrhetinic acid or knockdown of connexin 40 (Cx40) by transfecting GENCs with Cx40 short interfering RNA (siRNA) almost completely eliminated Delta[Ca(2+)](i) and the calcium wave. Breakdown of extracellular ATP using a scavenger cocktail (apyrase and hexokinase) or nonselective inhibition of purinergic P2 receptors with suramin, had similar blocking effects. Scraping cells off along a line eliminated physical contact between cells but did not effect calcium wave propagation. Using an ATP biosensor technique, we detected a significant elevation in extracellular ATP (Delta = 76 +/- 2 microM) during calcium wave propagation, which was abolished by Cx40 siRNA treatment (Delta = 6 +/- 1 microM). These studies suggest that connexin 40 hemichannels and extracellular ATP are key molecular elements of the glomerular endothelial calcium wave, which may serve important juxtaglomerular functions.

  5. Estimated glomerular filtration rate is a poor predictor of the concentration of middle molecular weight uremic solutes in chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Nathalie Neirynck

    Full Text Available BACKGROUND: Uremic solute concentration increases as Glomerular Filtration Rate (GFR declines. Weak associations were demonstrated between estimated GFR (eGFR and the concentrations of several small water-soluble and protein-bound uremic solutes (MW500 Da. MATERIALS AND METHODS: In 95 CKD-patients (CKD-stage 2-5 not on dialysis, associations between different eGFR-formulae (creatinine, Cystatin C-based or both and the natural logarithm of the concentration of several LMWP's were analyzed: i.e. parathyroid hormone (PTH, Cystatin C (CystC, interleukin-6 (IL-6, tumor necrosis factor-alpha (TNF-α, leptin, retinol binding protein (RbP, immunoglobin light chains kappa and lambda (Ig-κ and Ig-λ, beta-2-microglobulin (β(2M, myoglobin and fibroblast growth factor-23 (FGF-23. RESULTS: The regression coefficients (R(2 between eGFR, based on the CKD-EPI-Crea-CystC-formula as reference, and the examined LMWP's could be divided into three groups. Most of the LMWP's associated weakly (R(2 0.7. Almost identical R(2-values were found per LMWP for all eGFR-formulae, with exception of CystC and β(2M which showed weaker associations with creatinine-based than with CystC-based eGFR. CONCLUSION: The association between eGFR and the concentration of several LMWP's is inconsistent, with in general low R(2-values. Thus, the use of eGFR to evaluate kidney function does not reflect the concentration of several LMWP's with proven toxic impact in CKD.

  6. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts.

    Science.gov (United States)

    van der Velde, Marije; Matsushita, Kunihiro; Coresh, Josef; Astor, Brad C; Woodward, Mark; Levey, Andrew; de Jong, Paul; Gansevoort, Ron T; van der Velde, Marije; Matsushita, Kunihiro; Coresh, Josef; Astor, Brad C; Woodward, Mark; Levey, Andrew S; de Jong, Paul E; Gansevoort, Ron T; Levey, Andrew; El-Nahas, Meguid; Eckardt, Kai-Uwe; Kasiske, Bertram L; Ninomiya, Toshiharu; Chalmers, John; Macmahon, Stephen; Tonelli, Marcello; Hemmelgarn, Brenda; Sacks, Frank; Curhan, Gary; Collins, Allan J; Li, Suying; Chen, Shu-Cheng; Hawaii Cohort, K P; Lee, Brian J; Ishani, Areef; Neaton, James; Svendsen, Ken; Mann, Johannes F E; Yusuf, Salim; Teo, Koon K; Gao, Peggy; Nelson, Robert G; Knowler, William C; Bilo, Henk J; Joosten, Hanneke; Kleefstra, Nanno; Groenier, K H; Auguste, Priscilla; Veldhuis, Kasper; Wang, Yaping; Camarata, Laura; Thomas, Beverly; Manley, Tom

    2011-06-01

    Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.

  7. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate.

    Science.gov (United States)

    Goraya, Nimrit; Simoni, Jan; Jo, Chan-Hee; Wesson, Donald E

    2014-11-01

    Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR.

  8. The Cluster of Abnormalities Related to Metabolic Syndrome Is Associated With Reduced Glomerular Filtration Rate and Raised Albuminuria in Patients With Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Kurata, Miki; Takenouchi, Akiko; Tsuboi, Ayaka; Minato, Satomi; Takeuchi, Mika; Kitaoka, Kaori; Fukuo, Keisuke; Kazumi, Tsutomu

    2017-09-01

    As association of metabolic syndrome (MS) with chronic kidney disease (CKD) has not been extensively studied in patients with type 2 diabetes, we addressed these issues. Intrapersonal means of 12 measurements of waist circumference, blood pressure and high-density lipoprotein (HDL) cholesterol and those of six measurements of fasting triglycerides during 12 months were calculated in a cohort of 168 previously reported Japanese patients with type 2 diabetes. Based on these means, MS was diagnosed according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria with the Asian definition of abdominal obesity. CKD was defined as the presence of low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m(2)), albuminuria (urinary albumin/creatinine ratio (ACR) ≥ 30 mg/g) or both. Of 168 patients, 77 patients (46 %) had MS and 67 (40 %) had CKD. As the number of MS components increased from 1 through 5, the prevalence of albuminuria (9%, 38%, 30%, 41%, and 50%, P < 0.001), low eGFR (0%, 10%, 24%, 22%, and 50%, P < 0.001) and consequently, CKD increased (9%, 41%, 48%, 52%, and 75%, P < 0.001). Urinary ACR increased and eGFR decreased as a function of the number of MS components. As compared to patients without MS, prevalence of low eGFR (26% vs. 7%, P = 0.001) and CKD (52% vs. 30%, P = 0.005) was higher in patients with MS but prevalence of albuminuria did not differ (36% vs. 27%, P = 0.2). In Japanese patients with type 2 diabetes, the cluster of abnormalities related to MS was associated not only with higher prevalence of albuminuria, reduced kidney function and hence the increase in CKD but also with corresponding changes in urinary ACR and eGFR.

  9. Enzymatic creatinine assays allow estimation of glomerular filtration rate in stages 1 and 2 chronic kidney disease using CKD-EPI equation.

    Science.gov (United States)

    Kuster, Nils; Cristol, Jean-Paul; Cavalier, Etienne; Bargnoux, Anne-Sophie; Halimi, Jean-Michel; Froissart, Marc; Piéroni, Laurence; Delanaye, Pierre

    2014-01-20

    The National Kidney Disease Education Program group demonstrated that MDRD equation is sensitive to creatinine measurement error, particularly at higher glomerular filtration rates. Thus, MDRD-based eGFR above 60 mL/min/1.73 m² should not be reported numerically. However, little is known about the impact of analytical error on CKD-EPI-based estimates. This study aimed at assessing the impact of analytical characteristics (bias and imprecision) of 12 enzymatic and 4 compensated Jaffe previously characterized creatinine assays on MDRD and CKD-EPI eGFR. In a simulation study, the impact of analytical error was assessed on a hospital population of 24084 patients. Ability using each assay to correctly classify patients according to chronic kidney disease (CKD) stages was evaluated. For eGFR between 60 and 90 mL/min/1.73 m², both equations were sensitive to analytical error. Compensated Jaffe assays displayed high bias in this range and led to poorer sensitivity/specificity for classification according to CKD stages than enzymatic assays. As compared to MDRD equation, CKD-EPI equation decreases impact of analytical error in creatinine measurement above 90 mL/min/1.73 m². Compensated Jaffe creatinine assays lead to important errors in eGFR and should be avoided. Accurate enzymatic assays allow estimation of eGFR until 90 mL/min/1.73 m² with MDRD and 120 mL/min/1.73 m² with CKD-EPI equation.

  10. Estimation of Glomerular Filtration Rate in Elderly Chronic Kidney Disease Patients: Comparison of Three Novel Sophisticated Equations and Simple Cystatin C Equation.

    Science.gov (United States)

    Bevc, Sebastjan; Hojs, Nina; Hojs, Radovan; Ekart, Robert; Gorenjak, Maksimiljan; Puklavec, Ludvik

    2017-04-01

    Estimating glomerular filtration rate (GFR) in elderly patients is a problem, since they are poorly represented in studies developing GFR equations. Serum cystatin C is a better indicator of GFR than serum creatinine in elderly patients. Therefore the aim of our study was to compare frequently used serum cystatin C based GFR equations with a gold standard ((51) CrEDTA clearance) in elderly chronic kidney disease (CKD) patients. 106 adult Caucasian patients, older than 65 years (58 women, 48 men; mean age 72.5 years), were included. In each patient (51) CrEDTA clearance, serum creatinine (IDMS traceable method) and serum cystatin C (immunonephelometric method) were determined. GFR was estimated using the Simple cystatin C, CKD-EPI cystatin C, CKD-EPI creatinine-cystatin C and BIS2 equation. Mean serum creatinine of our patients was 141.4 ± 41.5 μmol/L, mean serum cystatin C 1.79 ± 0.6 mg/L, mean (51) CrEDTA clearance was 52.2 ± 15.9 mL/min per 1.73 m(2) . Statistically significant correlations between (51) CrEDTA clearance and all formulas were found (P C and BIS2 equation underestimated and CKD-EPI cystatin C and Simple cystatin C equation overestimated measured GFR. All equations lacked precision. Analysis of ability to correctly predict patient's GFR below or above 45 mL/min per 1.73 m(2) showed similar ability for all equations (P = 0.24-0.89). All equations are equally accurate for estimating GFR in elderly Caucasian CKD patients. For daily practice Simple cystatin C equation is most practical.

  11. Comparison of predictive accuracy of teicoplanin concentration using creatinine clearance and glomerular filtration rate estimated by serum creatinine or cystatin C.

    Science.gov (United States)

    Kozono, Aki; Hiraki, Yoichi; Adachi, Rui; Nagano, Masahisa; Inoue, Daisuke; Tsuji, Yasuhiro; Kamimura, Hidetoshi; Karube, Yoshiharu

    2016-05-01

    We compared the predictive accuracy of TEIC concentrations (TEIC_conc) calculated using either serum cystatin C (CysC) or serum creatinine (SCr) and the population mean method using the mean population parameter of TEIC_conc for Japan. We also compared the predicted TEIC_conc to measured TEIC_conc. Creatinine clearance (CLCr) predicted using the Cockcroft-Gault (C&G) equation with SCr was 45.23 mL/min (interquartile range [IQR]: 32.12-58.28), and the glomerular filtration rate (GFR) predicted using the Hoek equation with CysC was 45.23 mL/min (IQR: 35.40-53.79). The root mean-squared prediction error (IQR) based on CLCr predicted using the C&G equation with SCr was 6.88 (3.80-9.96) μg/mL, and that based on GFR predicted using the Hoek equation with CysC was 6.72 (3.77-9.68) μg/mL. Predicted TEIC_conc did not differ significantly between the two methods. The predictive accuracy of the TEIC_conc using the Hoek equation with CysC was similar to that of CLCr using the C&G equation with SCr. These findings suggest that the predictive accuracy of the TEIC_conc using CLCr based on the G&G equation and SCr might be sufficient for the initial dose adjustment of TEIC. Given that we were unable to confirm that CysC is the optimal method for predicting TEIC_conc, the expensive measurement of CysC might not be necessary.

  12. Impact of urine concentration adjustment method on associations between urine metals and estimated glomerular filtration rates (eGFR) in adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Virginia M., E-mail: vweaver@jhsph.edu [Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Johns Hopkins University School of Medicine, Baltimore, MD (United States); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Vargas, Gonzalo García [Faculty of Medicine, University of Juárez of Durango State, Durango (Mexico); Secretaría de Salud del Estado de Coahuila, Coahuila, México (Mexico); Silbergeld, Ellen K. [Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Rothenberg, Stephen J. [Instituto Nacional de Salud Publica, Centro de Investigacion en Salud Poblacional, Cuernavaca, Morelos (Mexico); Fadrowski, Jeffrey J. [Johns Hopkins University School of Medicine, Baltimore, MD (United States); Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (United States); Rubio-Andrade, Marisela [Faculty of Medicine, University of Juárez of Durango State, Durango (Mexico); Parsons, Patrick J. [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY (United States); Department of Environmental Health Sciences, School of Public Health, University at Albany, Albany, NY (United States); Steuerwald, Amy J. [Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY (United States); and others

    2014-07-15

    Positive associations between urine toxicant levels and measures of glomerular filtration rate (GFR) have been reported recently in a range of populations. The explanation for these associations, in a direction opposite that of traditional nephrotoxicity, is uncertain. Variation in associations by urine concentration adjustment approach has also been observed. Associations of urine cadmium, thallium and uranium in models of serum creatinine- and cystatin-C-based estimated GFR (eGFR) were examined using multiple linear regression in a cross-sectional study of adolescents residing near a lead smelter complex. Urine concentration adjustment approaches compared included urine creatinine, urine osmolality and no adjustment. Median age, blood lead and urine cadmium, thallium and uranium were 13.9 years, 4.0 μg/dL, 0.22, 0.27 and 0.04 g/g creatinine, respectively, in 512 adolescents. Urine cadmium and thallium were positively associated with serum creatinine-based eGFR only when urine creatinine was used to adjust for urine concentration (β coefficient=3.1 mL/min/1.73 m{sup 2}; 95% confidence interval=1.4, 4.8 per each doubling of urine cadmium). Weaker positive associations, also only with urine creatinine adjustment, were observed between these metals and serum cystatin-C-based eGFR and between urine uranium and serum creatinine-based eGFR. Additional research using non-creatinine-based methods of adjustment for urine concentration is necessary. - Highlights: • Positive associations between urine metals and creatinine-based eGFR are unexpected. • Optimal approach to urine concentration adjustment for urine biomarkers uncertain. • We compared urine concentration adjustment methods. • Positive associations observed only with urine creatinine adjustment. • Additional research using non-creatinine-based methods of adjustment needed.

  13. Relationship between the estimated glomerular filtration rate and kidney shear wave speed values assessed by acoustic radiation force impulse elastography: a pilot study.

    Science.gov (United States)

    Bob, Flaviu; Bota, Simona; Sporea, Ioan; Sirli, Roxana; Popescu, Alina; Schiller, Adalbert

    2015-04-01

    The aim of the study was to establish the relationship between the estimated glomerular filtration rate (GFR) and kidney shear wave speed values assessed by acoustic radiation force impulse (ARFI) elastography. Our study included 104 patients with or without chronic kidney disease in which the kidney shear wave speed was evaluated by ARFI elastography and correlated with the estimated GFR. Five ARFI measurements were performed in the parenchyma of each kidney. A median value expressed as meters per second was calculated. Five valid ARFI elastographic measurements were obtained in the right kidney in all patients and in the left kidney in 97.1% of patients. The mean kidney shear wave speed values ± SD in the right and left kidneys were similar: 2.17 ± 0.81 versus 2.06 ± 0.75 m/s (P = .30). The mean kidney shear wave speed decreased with the decrease in the estimated GFR. Statistically significant differences were obtained only when kidney shear wave speed values obtained in patients with an estimated GFR of greater than 90 mL/min/1.73 m(2) were compared to values in patients with stage 4 (estimated GFR, 15-29 mL/min/1.73 m(2)) and stage 5 (estimated GFR, wave speed had 86.7% sensitivity, 48.3% specificity, a 22.1% positive predictive value, and a 95.6% negative predictive value (area under the receiver operating characteristic curve, 0.692; P = .008) for predicting the presence of an estimated GFR of less than 30 mL/min/1.73 m(2). Kidney shear wave speed values obtained by ARFI elastography decrease with the decrease in the estimated GFR. © 2015 by the American Institute of Ultrasound in Medicine.

  14. Impact of pregnancy on underlying renal disease.

    Science.gov (United States)

    Baylis, Chris

    2003-01-01

    Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progression of renal disease in nonpregnant states by glomerular hypertension, there are no long-term deleterious effects of pregnancies on the kidney when maternal renal function is normal because glomerular blood pressure remains normal. When maternal renal function is compromised before conception, there are no long-term adverse effects on renal function in most types of renal disease, providing that the GFR is well maintained before conception. When serum creatinine exceeds approximately 1.4 mg/dL, pregnancy may accelerate the renal disease increases and when serum creatinine >2 mg/dL, the chances are greater than 1 in 3 that pregnancy will hasten the progression of the renal disease. The available animal studies suggest that glomerular hypertension does not occur despite diverse injuries. Thus, the mechanisms of the adverse interaction between pregnancy and underlying renal disease remain unknown.

  15. Role of vascular potassium channels in the regulation of renal hemodynamics

    DEFF Research Database (Denmark)

    Sørensen, Charlotte Mehlin; Braunstein, Thomas Hartig; von Holstein-Rathlou, Niels-Henrik

    2012-01-01

    of one or more classes of K+ channels will lead to a change in hemodynamic resistance and therefore of renal blood flow and glomerular filtration pressure. Through these effects, the activity of renal vascular K+ channels influences renal salt and water excretion, fluid homeostasis, and ultimately blood...

  16. Pharmacokinetic-pharmacodynamic assessment of the interrelationships between tesaglitazar exposure and renal function in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Hamrén, Bengt; Ohman, K Peter; Svensson, Maria K; Karlsson, Mats O

    2012-09-01

    The effects of tesaglitazar on renal function (assessed as urinary clearance of 125I-sodium iothalamate or estimated by the modification of diet in renal disease formula) were studied in a 24-week open-label trial in type 2 diabetes mellitus patients randomized to daily doses of either tesaglitazar 2 mg or pioglitazone 45 mg. The aim of the analysis was to develop a population pharmacokinetic-pharmacodynamic model that could simultaneously describe the interrelationship between tesaglitazar exposure and reduction in renal function over time in patients with type 2 diabetes mellitus. The pharmacokinetic-pharmacodynamic model could adequately describe the interplay between tesaglitazar and glomerular filtration rate. A one-compartment model in which the apparent clearance was influenced by glomerular filtration rate characterized the pharmacokinetics of tesaglitazar. An indirect-response model was used for the slow time course of change in glomerular filtration rate, which decreased from 100 to 78 mL/min/1.73m(2) after 12 weeks of treatment. All tesaglitazar-treated patients had a reduction in glomerular filtration rate, and available demographic variables could not explain differences in response. Patients treated with an angiotensin converting enzyme inhibitor were more sensitive to tesaglitazar and had larger glomerular filtration rate decrease compared to nontreated patients. Approximately 8 weeks after discontinuing treatment, mean glomerular filtration rate had returned towards baseline. The model and data give valuable insights into the dynamic changes in glomerular filtration rate over time.

  17. Combined effects of moderately elevated blood glucose and locally produced TGF-beta1 on glomerular morphology and renal collagen production

    DEFF Research Database (Denmark)

    Krag, Søren; Nyengaard, Jens R; Wogensen, Lise

    2007-01-01

    BACKGROUND: There is a correlation between renal graft rejection and blood glucose (BG) levels. Furthermore, diabetic patients may develop non-diabetic renal diseases, which in some circumstances progress rapidly. Since transforming growth factor-beta1 (TGF-beta) levels are elevated in many renal...... diseases, the accelerated progression may be due to interactions between glucose and locally produced TGF-beta1. Therefore, we investigated the effect of mild hyperglycaemia on glomerular morphology and collagen production in TGF-beta1 transgenic mice. METHODS: To achieve BG concentrations of approximately...... is involved. This emphasizes the importance of strict BG control in renal transplant patients and diabetic patients with renal malfunctions unrelated to diabetes. Udgivelsesdato: 2007-Sep...

  18. Relationships of pancreatic beta-cell function with microalbuminuria and glomerular filtration rate in middle-aged and elderly population without type 2 diabetes mellitus: a Chinese community-based analysis

    Directory of Open Access Journals (Sweden)

    Fu S

    2017-05-01

    Full Text Available Shihui Fu,1,2 Shanjing Zhou,3 Leiming Luo,1 Ping Ye1 1Department of Geriatric Cardiology, 2Department of Cardiology and Hainan Branch, 3Department of Traditional Chinese Medicine and Hainan Branch, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Relationships of pancreatic beta-cell function abnormality with microalbuminuria (MA and glomerular filtration rate (GFR may differ by age, ethnicity and accompanied diseases. Previous studies were generally conducted in Western adult patients with type 2 diabetes mellitus (T2DM, and it is uncertain whether pancreatic beta-cell function is associated with MA and GFR in Chinese community-dwelling middle-aged and elderly population without T2DM. We therefore examined the relationships of pancreatic beta-cell function with two indices of renal damage, MA and GFR, in Chinese community-dwelling middle-aged and elderly population without T2DM.Methods: This analysis focused on 380 Beijing residents older than 45 years who were free of T2DM and completed the evaluation of pancreatic beta-cell function.Results: Median age was 67 (49–80 years. Levels of triglyceride, diastolic blood pressure and homeostasis model assessment-beta (HOMA-beta index were positively related to urine microalbumin (P<0.05 for all. Age, low-density lipoprotein cholesterol levels and HOMA-beta index were inversely correlated with GFR, while high-density lipoprotein cholesterol levels were positively correlated with GFR (P<0.05 for all. In all three adjustment models, there was a significant positive association between HOMA-beta index and MA; subjects with higher beta-cell function had higher odds of MA (P<0.05 for all. There was no association between HOMA-beta index and GFR <60 mL/min/1.73 m2 in any model (P>0.05 for all.Conclusion: Modeling the pancreatic beta-cell function with different adjusted variables provided the same conclusion of association with MA; beta

  19. 估算肾小球滤过率在健康体检中的应用及相关因素分析%APPLICATION OF ESTIMATED GLOMERULAR FILTRATION RATE IN HEALTH EXAMINATION AND ANALYSIS OF RELEVANT FACTORS

    Institute of Scientific and Technical Information of China (English)

    李宝全; 李贵连; 安翠平; 杨燕; 崔文丽; 周琰

    2013-01-01

    Objective To validate the application of estimated glomerular filtration rate ( eGFR ) calculated with chronic kidney disease epidemiology collaboration predictive equation based on serum creatinine ( SCr ) and cystatin C ( Cys C ) in health examination and analyze its relevant factors. Methods The concentration of SCr and Cys C were measured and the eGFR was estimated with the SCr/ Cys C combinated equation of Chinese eGFR Investigation Collaborative Group in 571 healthy examination persons. The Spearman correlation analysis was performed and all data were analyzed. Results The eGFR was negatively correlated with body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, γ-glutamyltransferase, uric acid, total cholesterol, triglyceride, low density lipoprotein-cholesterol( P < 0. 01 ), but was positively correlated with the pH value, high density lipoprotein-cholesterol and urine β2 microglobulin /creatinine ( P < 0. 01 ). Conclusion The results of this study indicated that the application of eGFR is sensitive to evaluate the renal function in health examination.%目的 应用血清肌酐(serum creatinine,SCr)和胱抑素C(cystatin C,Cys C)的联合方程估算肾小球滤过率(estimated glomerular filtration rate,eGFR),探讨eGFR在健康体检中的应用,并对eGFR相关因素进行分析,旨在早期发现肾功能受损.方法 测量571例健康体检者SCr和Cys C浓度,应用中国eGFR 课题协作组公式计算eGFR,对eGFR结果及相关因素进行分析.结果 eGFR与体质量指数、收缩压、舒张压、血丙氨酸转氨酶、谷氨酰转移酶、尿酸、胆固醇、三酰甘油、低密度脂蛋白胆固醇均呈负相关,差异有统计学意义(P<0.01);eGFR与尿液pH、高密度脂蛋白胆固醇、尿β2微球蛋白肌酐比值均呈正相关,差异有统计学意义(P<0.01).结论 应用eGFR可早期提示肾功能异常,对其相关危险因素早期进行干预,可提高健康水平.

  20. An empirical research of four equations for estimated glomerular filtration rate among mass samples%4个肾小球滤过率估计公式的人群实证研究

    Institute of Scientific and Technical Information of China (English)

    汪秀英; 黄蕾蕾; 宋慧; 丁伟洁; 陈茂杰; 卓朗

    2011-01-01

    Objective To investigate the features of each glomerular filtration rate (GFR) equation in calculating the estimated glomerular filtration rate (eGFR) among mass samples, and to provide guidance to the appropriate equation selections of in the estimation of eGFR. Methods The mass samples were based on the physical examination data in recent years in Xuzhou. Simplified MDRD equation, modified MDRD equation, racial coefficient equation and Ruijin equation were designated to compare differences in statistic indexes and evaluate each equation via dynamic diagrammatic trends. Results Of the four equations, the means of eGFR by simplified MDRD equation were approximate to those by modified MDRD equation, with those by Ruijin equation at the nadir and those by racial coefficient equation at the peak.The standardized rate of reduced renal function was 0.53%, 0.45%, 0.62% and 0. 17%, respectively. The standardized rate of chronic kidney disease (CKD) was 11.71%, 11.66%, 11.81% and 11.46%, respectively. Conclusion The CKD in population study consists in hematuria and proteinuria, with little bias between different equations. Simplified MDRD equation or modified MDRD equation is still preferable in the study of the prevalence of CKD until new biochemical indicator is adopted to substitute serum creatinine so as to facilitate horizontal and vertical comparisons among relevant studies.%目的 通过使用不同的肾小球滤过率(GFR)公式估计人群的估计GFR(eGFR),了解不同公式的特征,指导正确选用公式有效估计eGFR.方法 本研究使用徐州地区近年来健康体检者的资料,比较简化MDRD公式、国内改良MDRD公式、种族系数公式和瑞金方程,比较各种统计指标之间的差异,通过图表的动态变化来判断各公式的价值.结果 简化MDRD公式的eGFR值与国内改良MDRD公式接近,瑞金方程最低,种族系数公式最高.肾功能下降标化患病率依次为0.53%、0.45%、0.62%、0.17%,慢

  1. Chronic renal failure among HIV-1-infected patients

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Kirk, Ole; Gatell, Jose

    2007-01-01

    BACKGROUND: The role of exposure to antiretrovirals in chronic renal failure (CRF) is not well understood. Glomerular filtration rates (GFR) are estimated using the Cockcroft-Gault (CG) or Modification of Diet in Renal Disease (MDRD) equations. METHODS: Baseline was arbitrarily defined as the first...

  2. Chronic renal failure among HIV-1-infected patients

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Kirk, Ole; Gatell, Jose

    2007-01-01

    BACKGROUND: The role of exposure to antiretrovirals in chronic renal failure (CRF) is not well understood. Glomerular filtration rates (GFR) are estimated using the Cockcroft-Gault (CG) or Modification of Diet in Renal Disease (MDRD) equations. METHODS: Baseline was arbitrarily defined as the first...

  3. Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation

    NARCIS (Netherlands)

    Rook, M; Hofker, HS; van Son, WJ; van der Heide, JJH; Ploeg, RJ; Navis, GJ

    2006-01-01

    Kidney transplantation from living donors is important to reduce organ shortage. Reliable pre-operative estimation of post-donation renal function is essential. We evaluated the predictive potential of pre-donation glomerular filtration rate (GFR) (iothalamate) and renal reserve capacity for post-do

  4. Nephrectomy elicits impact of age and BMI on renal hemodynamics : Lower postdonation reserve capacity in older or overweight kidney donors

    NARCIS (Netherlands)

    Rook, M.; Bosma, R. J.; van Son, W. J.; Hofker, H. S.; van der Heide, J. J. Homan; ter Wee, P. M.; Ploeg, R. J.; Navis, G. J.

    2008-01-01

    Renal functional reserve could be relevant for the maintenance of renal function after kidney donation. Low-dose dopamine induces renal vasodilation with a rise in glomerular filtration rate (GFR) in healthy subjects and is thought to be a reflection of reserve capacity (RC). Older age and higher bo

  5. Effect of canagliflozin on serum electrolytes in patients with type 2 diabetes in relation to estimated glomerular filtration rate (eGFR).

    Science.gov (United States)

    Weir, Matthew R; Kline, Irina; Xie, John; Edwards, Robert; Usiskin, Keith

    2014-09-01

    Effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on serum electrolytes were evaluated using pooled data from studies of patients with type 2 diabetes mellitus (T2DM). Analyses were performed using two datasets, each including four placebo-controlled studies: Population 1 (N = 2215), patients with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) (mean = 89.6 mL/min/1.73 m(2)) and Population 2 (N = 721), patients with baseline eGFR ≥45 and canagliflozin 100 and 300 mg or placebo. Potassium changes were further evaluated based on baseline therapy with anti-hypertensive agents that interfere with potassium excretion (renin-angiotensin aldosterone system-acting agents and/or potassium-sparing diuretics). Mean percent changes from baseline in potassium with canagliflozin 100 and 300 mg and placebo were 0.6%, 1.0%, and 0.5%, respectively (Week 26; Population 1); and 1.7%, 2.8%, and 0.7%, respectively (Week 18/26; Population 2). The proportion of patients who had potassium elevations meeting pre-defined outlier criteria (>5.4 mmol/L [5.4 mEq/L] and >15% increase from baseline) with canagliflozin 100 and 300 mg and placebo was 4.5%, 6.8%, and 4.7% (Population 1); and 5.2%, 9.1%, and 5.5% (Population 2). In both populations, potassium elevations were usually canagliflozin or placebo; elevations ≥6.5 mmol/L were rare but more frequent in patients taking anti-hypertensive agents that affect potassium excretion in both the canagliflozin and placebo groups. Small mean percent changes in sodium, bicarbonate, and calcium were seen across groups in both populations; small mean percent increases in magnesium and phosphate were seen with canagliflozin vs placebo, but without an increase in patients meeting outlier criteria. Adverse events related to changes in electrolytes were low across groups. In patients with T2DM, canagliflozin was generally associated with small mean percent changes in serum

  6. Relationship of arterial compliance and blood pressure with microalbuminuria and mildly decreased glomerular filtration rate: a Chinese community-based analysis.

    Directory of Open Access Journals (Sweden)

    Shihui Fu

    Full Text Available This analysis is designed to determine the prevalence of microalbuminuria (MAU and mildly decreased glomerular filtration rate (GFR; to investigate the association of augmentation index (AIx, central blood pressure (cBP and peripheral blood pressure (pBP with MAU and mildly decreased GFR; and to compare the association strength of cBP and pBP with MAU and mildly decreased GFR.This community-based analysis included 2071 Chinese residents. Urine albumin-to-creatinine ratio (UACR, GFR, and pulse wave measurements were performed. UACR of 30-299 mg/g and GFR of 60-89 ml/min/1.73 m2 were identified as MAU and mildly decreased GFR.The prevalence of MAU and mildly decreased GFR was 21.3% and 33.2%. The AIx, cBP and pBP were significantly higher in participants with MAU compared with those without MAU, and in participants with mildly decreased GFR compared with those without mildly decreased GFR (all P<0.001. After participants were categorized into four subgroups based on the presence or absence of MAU and mildly decreased GFR, Aix, cBP and pBP progressively increased from the subgroup without both of MAU and mildly decreased GFR to the subgroups with either one of them, and arrived at top in the subgroup with both of them (all P<0.001. Compared with the reference category without MAU and mildly decreased GFR, the odd ratio values significantly increased from the category with either one of MAU and mildly decreased GFR to the category with both of them (all P<0.001. The AIx, cBP and pBP were all independently associated with MAU and mildly decreased GFR after full adjustment (all P<0.05, and the association strength of MAU and mildly decreased GFR with cBP was similar to those with pBP.In Chinese community-dwelling population, there was a high prevalence of MAU and mildly decreased GFR. The AIx, cBP and pBP were all independently associated with MAU and mildly decreased GFR; meanwhile, cBP did not exhibit stronger association with MAU and mildly

  7. Comparison of Glomerular Filtration Rate Estimation from Serum Creatinine and Cystatin C in HNF1A-MODY and Other Types of Diabetes

    Directory of Open Access Journals (Sweden)

    Magdalena Szopa

    2015-01-01

    Full Text Available Introduction. We previously showed that in HNF1A-MODY the cystatin C-based glomerular filtration rate (GFR estimate is higher than the creatinine-based estimate. Currently, we aimed to replicate this finding and verify its clinical significance. Methods. The study included 72 patients with HNF1A-MODY, 72 with GCK-MODY, 53 with type 1 diabetes (T1DM, 70 with type 2 diabetes (T2DM, and 65 controls. Serum creatinine and cystatin C levels were measured. GFR was calculated from creatinine and cystatin C using the CKD-EPI creatinine equation (eGRF-cr and CKD-EPI cystatin C equation (eGFR-cys, respectively. Results. Cystatin C levels were lower (p<0.001 in the control (0.70±0.13 mg/L, HNF1A (0.75±0.21, and GCK (0.72±0.16 mg/L groups in comparison to those with either T1DM (0.87±0.15 mg/L or T2DM (0.9±0.23 mg/L. Moreover, eGFR-cys was higher than eGRF-cr in HNF1A-MODY, GCK-MODY, and the controls (p=0.004; p=0.003; p<0.0001. This corresponded to 8.9 mL/min/1.73 m2, 9.7 mL/min/1.73 m2, and 16.9 mL/min/1.73 m2 of difference. Additionally, T1DM patients had higher eGFR-cr than eGFR-cys (11.6 mL/min/1.73 m2; p=0.0004; no difference occurred in T2DM (p=0.91. Conclusions. We confirmed that eGFR-cys values in HNF1A-MODY patients are higher compared to eGFR-cr. Some other differences were also described in diabetic groups. However, none of them appears to be clinically relevant.

  8. Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate.

    Science.gov (United States)

    McDonald, Jennifer S; McDonald, Robert J; Carter, Rickey E; Katzberg, Richard W; Kallmes, David F; Williamson, Eric E

    2014-04-01

    To determine the effect of baseline estimated glomerular filtration rate (eGFR) on the causal association between intravenous iodinated contrast material exposure and subsequent development of acute kidney injury (AKI) in propensity score-matched groups of patients who underwent contrast material-enhanced or unenhanced computed tomography (CT). This retrospective study was HIPAA compliant and institutional review board approved. All patients who underwent contrast-enhanced (contrast material group) or unenhanced (non-contrast material group) CT between 2000 and 2010 were identified and stratified according to baseline eGFR by using Kidney Disease Outcomes Quality Initiative cutoffs for chronic kidney disease into subgroups with eGFR of 90 or greater, 60-89, 30-59, and less than 30 mL/min/1.73 m(2). Propensity score generation and 1:1 matching of patients were performed in each eGFR subgroup. Incidence of AKI (serum creatinine [SCr] increase of ≥0.5 mg/dL [≥44.2 μmol/L] above baseline) was compared in the matched subgroups by using the Fisher exact test. A total of 12 508 propensity score-matched patients with contrast-enhanced and unenhanced scans met all inclusion criteria. In this predominantly inpatient cohort, the incidence of AKI significantly increased with decreasing baseline eGFR (P material and non-contrast material groups in any eGFR subgroup; for the subgroup with eGFR of 90 or greater (n = 1642), odds ratio (OR) was 0.91 (95% confidence interval [CI]: 0.38, 2.15), P = .82; for the subgroup with eGFR of 60-89 (n = 3870), OR was 1.03 (95% CI: 0.66, 1.60), P = .99; for the subgroup with eGFR of 30-59 (n = 5510), OR was 0.94 (95% CI: 0.76, 1.18), P = .65; and for the subgroup with eGFR of less than 30 mL/min/1.73 m(2) (n = 1486), OR was 0.97 (95% CI: 0.72, 1.30), P = .89. Diminished eGFR is associated with an increased risk of SCr-defined AKI following CT examinations. However, the risk of AKI is independent of contrast material exposure, even in

  9. Estimating glomerular filtration rates in elderly Chinese patients with chronic kidney disease: performance of six modified formulae developed in Asian populations

    Directory of Open Access Journals (Sweden)

    Liu X

    2013-07-01

    Full Text Available Xun Liu,1,2,* Haixia Xu,3,* Zebin Zheng,4,5,* Cheng Wang,1 Cailian Cheng,1 Chenggang Shi,1 Yihong Gong,4,5 Ming Li,1 Tanqi Lou1 1Division of Nephrology, Department of Internal Medicine, The Third Affiliated Hospital of Sun Yat-sen University, 2College of Biology Engineering, South China University of Technology, 3Division of Endocrinology, Department of Internal Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; 4Department of Biomedical Engineering, School of Engineering, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China; 5Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instruments, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China *These authors contributed equally to this work Objectives: The aim of the present study was to evaluate modified glomerular filtration rate (GFR prediction formulae in an elderly Chinese population with chronic kidney disease (CKD. Methods: A total of 378 elderly Chinese patients with CKD were enrolled. The GFR was estimated with six modified GFR prediction formulae. The performances of the estimated GFRs were compared with those of the standard GFRs measured by technetium-99m diethylenetraminepentaacetic acid. Results: Biases were similar for Chinese formula 1, the Asian formula, and Chinese formula 2 (median difference, 2.22 mL/min/1.73 m2 and 2.59 mL/min/1.73 m2 for Chinese formula 1 and the Asian formula, respectively, versus (vs 3.69 mL/min/1.73 m2 for Chinese formula 2 [P = 0.298 and P = 0.913, respectively]. Precision was improved with the Japanese formula (interquartile range of the difference, 3.14 mL/min/1.73 m2 of the Japanese formula versus 15.53–23.06 mL/min/1.73 m2 of the other formulae. The accuracy of Chinese formula 2 was the highest (30% accuracy, 59.3% vs range 37.8–54.0% [P < 0.05 for all comparisons]. However, none of the modified formulae surpassed the acceptable

  10. Measurement of glomerular filtration rate by dynamic contrast-enhanced magnetic resonance imaging using a subject-specific two-compartment model.

    Science.gov (United States)

    Tipirneni-Sajja, Aaryani; Loeffler, Ralf B; Oesingmann, Niels; Bissler, John; Song, Ruitian; McCarville, Beth; Jones, Deborah P; Hudson, Melissa; Spunt, Sheri L; Hillenbrand, Claudia M

    2016-04-01

    Measuring glomerular filtration rate (GFR) by dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) as part of standard of care clinicalMRIexams (e.g., in pediatric solid tumor patients) has the potential to reduce diagnostic burden. However, enthusiasm for this relatively newGFRtest may be curbed by the limited amount of cross-calibration studies with referenceGFRtechniques and the vast variety ofMRtracer model algorithms causing confusion on the choice of model. To advanceMRI-basedGFRquantification via improvedGFRmodeling and comparison with associated(99m)Tc-DTPA-GFR, 29 long-term Wilms' tumor survivors (19.0-43.3 years, [median 32.0 ± 6.0 years]) treated with nephrectomy, nonnephrotoxic chemotherapy ± radiotherapy underwentMRIwith Gd-DTPAadministration and a(99m)Tc-DTPA GFRtest. ForDCE-MRI-basedGFRestimation, a subject-specific two-compartment (SS-2C) model was developed that uses individual hematocrit values, automatically defines subject-specific uptake intervals, and fits tracer-uptake curves by incorporating these measures. The association between reference(99m)Tc-DTPA GFRandMR-GFRs obtained bySS-2C, three published 2C uptake, and inflow-outflow models was investigated via linear regression analysis. Uptake intervals varied from 64 sec to 141 sec [96 sec ± 21 sec] and hematocrit values ranged from 30% to 49% [41% ± 4%]; these parameters can therefore not be assumed as constants in 2C modeling. OurMR-GFRestimates using theSS-2C model showed accordingly the highest correlation with(99m)Tc-DTPA-GFRs (R(2) = 0.76,P < 0.001) compared with other models (R(2)-range: 0.36-0.66). In conclusion,SS-2C modeling ofDCE-MRIdata improved the association betweenGFRobtained by(99m)Tc-DTPAand Gd-DTPA DCE-MRIto such a degree that this approach could turn into a viable, diagnosticGFRassay without radiation exposure to the patient.

  11. Estimating kidney function in HIV-infected adults in Kenya: comparison to a direct measure of glomerular filtration rate by iohexol clearance.

    Directory of Open Access Journals (Sweden)

    Christina M Wyatt

    Full Text Available BACKGROUND: More than two-thirds of the world's HIV-positive individuals live in sub-Saharan Africa, where genetic susceptibility to kidney disease is high and resources for kidney disease screening and antiretroviral therapy (ART toxicity monitoring are limited. Equations to estimate glomerular filtration rate (GFR from serum creatinine were derived in Western populations and may be less accurate in this population. METHODS: We compared results from published GFR estimating equations with a direct measure of GFR by iohexol clearance in 99 HIV-infected, ART-naïve Kenyan adults. Iohexol concentration was measured from dried blood spots on filter paper. The bias ratio (mean of the ratio of estimated to measured GFR and accuracy (percentage of estimates within 30% of the measured GFR were calculated. RESULTS: The median age was 35 years, and 60% were women. The majority had asymptomatic HIV, with median CD4+ cell count of 355 cells/mm(3. Median measured GFR was 115 mL/min/1.73 m(2. Overall accuracy was highest for the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI equation. Consistent with a prior report, bias and accuracy were improved by eliminating the coefficient for black race (85% of estimates within 30% of measured GFR. Accuracy of all equations was poor in participants with GFR 60-90 mL/min/1.73 m(2 (<65% of estimates within 30% of measured GFR, although this subgroup was too small to reach definitive conclusions. CONCLUSIONS: Overall accuracy was highest for the CKD-EPI equation. Eliminating the coefficient for race further improved performance. Future studies are needed to determine the most accurate GFR estimate for use in individuals with GFR <90 mL/min/1.73 m(2, in whom accurate estimation of kidney function is important to guide drug dosing. Direct measurement of GFR by iohexol clearance using a filter paper based assay is feasible for research purposes in resource-limited settings, and could be used to develop more accurate

  12. Multicenter study of creatinine- and/or cystatin C-based equations for estimation of glomerular filtration rates in Chinese patients with chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Jia-fu Feng

    Full Text Available OBJECTIVE: To establish equations for the estimation of glomerular filtration rates (eGFRs based on serum creatinine (SCr and/or serum cystatin C (SCysC in Chinese patients with chronic kidney disease (CKD, and to compare the new equations with both the reference GFR (rGFR and the literature equations to evaluate their applicability. METHODS: The 788 Chinese CKD patients were randomly divided into two groups, the training group and the testing group, to establish new eGFR-formulas based on serum CysC and to validate the established formulas, respectively. (99mTc-DTPA clearance (as the rGFR, serum Cr, and serum CysC were determined for all patients, and GFR was calculated using the Cockcroft-Gault equation (eGFR1, the MDRD formula (eGFR2, the CKD-EPI formulas (eGFR3, eGFR4, and the Chinese eGFR Investigation Collaboration formulas (eGFR5, eGFR6. The accuracy of each eGFR was compared with the rGFR. RESULTS: The training and testing groups' mean GFRs were 50.84±31.36 mL/min/1.73 m(2 and 54.16±29.45 mL/min/1.73 m(2, respectively. The two newly developed eGFR formulas were fitted using iterative computation: [Formula: see text] and [Formula: see text]. Significant correlation was observed between each eGFR and the rGFR. However, proportional errors and constant errors were observed between rGFR and eGFR1, eGFR2, eGFR4, eGFR5 or eGFR6, and constant errors were observed between eGFR3 and rGFR, as revealed by the Passing & Bablok plot analysis. The Bland-Altman analysis illustrated that the 95% limits of agreement of all equations exceeded the previously accepted limits of <60 mL/min •1.73 m(2, except the equations of eGFR7 and eGFR8. CONCLUSION: The newly developed formulas, eGFR7 and eGFR8, provide precise and accurate GFR estimation using serum CysC detection alone or in combination with serum Cr detection. Differences in detection methods should be carefully considered when choosing literature eGFR equations to avoid misdiagnosis and

  13. 代谢综合征与尿微量清蛋白及肾小球滤过率的相关性研究%Associations of Metabolic Syndrome with Urinary Albumin and Glomerular Filtration Rate

    Institute of Scientific and Technical Information of China (English)

    张燕华; 朱义革; 陈蕊华

    2012-01-01

    Objective To investigate the association of the metabolic syndrome with urinary albumin excretion and glomerular filtration rate. Methods From October 2008 to March 2010,452 subjects without diabetes mellitus, glomerular disease and medication intaking was enrolled in this study. (125 female,327 male,mean age was 52±1. 9 years and mean BMI was 23. 8 ±0. 8 kg/m2). Subjects was divided into metabolic syndrome group (n=58,mail/female=44/14) ,and control group (n= 394,mail/female=282/112) according to IDF (International Association of endocrine surgeons) standard. Data of smoking history,waistline,blood pressure,lipids,fasting glucose,serum creatinine,glomerular filtration rate (GFR) and urinary albumin was collect and analyzed. Results Urinary albumin excretion increased significantly ( P<0. 05) and glomerular filtration rate showed insignificant decrease (P<0. 05) in patients with metabolic syndrome. Of all the 5 metabolic syndrome components and other clinical characteristics, systolic blood pressure was the independent determinant for the urinary protein excretion and glomerular filtration rate(OR=l. 13,95% CI:1. 11 — 1. 15,P<0. 01). Conclusion Metabolic syndrome could be a clinical syndrome which is associated with vascular dysfunction. But it showed a negative relationship with glomerular filtration rate in the people without diabetes, glomerular disease and medication consumption.%目的 研究代谢综合征与尿微量清蛋白排泄量及肾小球滤过率的相关性.方法 2008年10月~2010年3月入组452例无糖尿病,无肾小球疾病及不服药的健康体检者(女性125例,男性327例,平均年龄52±1.9岁,平均体重指数23.8±0.8 kg/m2).根据IDF(国际内分泌协会)标准分为代谢综合征组和正常对照组.收集并比较研究对象的吸烟史、腰围、血压、血脂、空腹血糖、血肌酐和尿微量清蛋白情况.结果代谢综合征组的吸烟率、腰围、收缩压、三酰甘油、低密度脂蛋白、空腹

  14. Application of estimated glomerular filtration rate formulae for different stages of chronic kidney disease in diabetes%肾小球滤过率预测公式在糖尿病合并慢性肾脏病不同分期中的适用性

    Institute of Scientific and Technical Information of China (English)

    孙科; 荆春艳; 刘永菊; 王东; 王菊梅; 董林; 姜妍芳; 李素梅

    2015-01-01

    目的 评价肾小球滤过率(glomerular filtration rate,GFR)预测公式在糖尿病肾脏疾病(diabetic kidney disease,DKD)不同分期中的适用性.方法 收集274例住院2型糖尿病患者的临床资料.采用中国改良肾脏病膳食改善实验(modification of diet in renal disease,MDRD)公式、瑞金公式及慢性肾脏病流行病学合作研究(chronic kidney disease epidemiology collaboration,CKD-EPI)公式估算的肾小球滤过率(estimated glomerular filtration rate,eG-FR)与99m锝-二乙烯三胺五乙酸(99mTc-diethylene triamine pentacetic acid,99mTc-DTPA)肾动态显像检查双肾GFR(referred glomerular filtration rate,rGFR)作为参考标准比较.比较上述3公式在GFR正常组(A组)、降低组(B组)、慢性肾脏疾病组(C组)的适用性.结果 在A、B两组,瑞金公式和CKD-EPI公式间eGFR的偏差值及偏差绝对值百分数、30%及50%符合率的差异无统计学意义(均有P>0.05);2者较中国改良MDRD公式eGFR的偏差值、偏差绝对值百分数小,30%、50%符合率高,差异有统计学意义(均有P<0.05).C组,3公式的上述指标两两之间的差异均无统计学意义(均有P >0.05).Bland-Altman作图法显示,瑞金方程eGFR的一致性最好.结论 瑞金方程eGFR可能更适合于评估中国DKD患者的GFR,尤其是早期肾功能损害者.

  15. A comparison of estimated glomerular filtration rate equations in very elderly patients with chronic kidney disease%高龄慢性肾脏病患者肾小球滤过率估算公式比较

    Institute of Scientific and Technical Information of China (English)

    傅辰生; 冯欣慧; 张晓丽; 盛蔚文; 陆轶君; 叶志斌

    2012-01-01

    Objective To compare the performances of commonly-used estimated glomerular filtration rate equations in very elderly patients with chronic kidney disease. Methods isotope scanning CFR as golden standard, the precision and accuracy of several commonly-used estimated glomerular filtration rate equations were evaluated in 334 very elderly patients with chronic kidney disease. Results The performances of CG or MDRD equations were unsatisfying. Data transformation might improve the performance. Conclusions It should be prudent when using CC or MDRD equations to estimate the glomerular filtration rates of very elderly patients with chronic kidney disease. Individual choose of equations, proper data transformation and direct investigation of glomerular filtration rate or creatinine clearance rate should be used if necessary.%目的 研究常用的肾小球滤过率估算公式在老龄慢性肾脏病(CKD)患者中的适用性.方法 以同位素显像法测定的患者肾小球滤过率为标准,评价常用的肾小球滤过率估算公式用于334例高龄CKD患者的精确度和准确度.结果 目前最常用的CG和MDRD系列公式在估算高龄CKD患者肾小球滤过率时均无法达到临床需要的估算效能.经过数据转换,可以改善这些公式的精确度和准确度.结论 在以常用的肾小球滤过率公式评价高龄CKD患者肾功能时需审慎,建议个体化选用公式,适当数据转换,必要时直接测定肾小球滤过率或内生肌酐清除率.

  16. The correct renal function evaluation in patients with thyroid dysfunction.

    Science.gov (United States)

    Simeoni, Mariadelina; Cerantonio, Annamaria; Pastore, Ida; Liguori, Rossella; Greco, Marta; Foti, Daniela; Gulletta, Elio; Brunetti, Antonio; Fuiano, Giorgio

    2016-05-01

    Thyroid dysfunction induces several renal derangements involving all nephron portions. Furthermore, dysthyroidism is a recognized risk factor associated with the development of chronic kidney disease. Current data, in fact, demonstrate that either subclinical or overt thyroid disease is associated with significant changes in creatinine, estimated glomerular filtration rate, measured glomerular filtration rate and Cystatin C. Herein, we systematically reviewed several relevant studies aiming at the identification of the most sensitive and specific parameter for the correct renal function evaluation in patients with thyroid dysfunction, that are usually treated as outpatients. Our systematic review indicates that estimated glomerular filtration rate, preferably with CKD-EPI equation, appears to be the most reliable and wieldy renal function parameter. Instead, Cystatin C should be better used in the grading of thyroid dysfunction severity.

  17. A look at risk factors of proteinuria in subjects without impaired renal filtration function in a general population in Owerri, Nigeria.

    Science.gov (United States)

    Anyabolu, Ernest Ndukaife; Chukwuonye, Innocent Ijezie; Anyabolu, Arthur Ebelenna; Enwere, Okezie

    2016-01-01

    Proteinuria is a common marker of kidney damage. This study aimed at determining predictors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria. This was a cross-sectional study involving 136 subjects, consecutively drawn from Federal Medical Centre (FMC), Owerri, Nigeria. Relevant investigations were performed, including 24-hour urine protein (24HUP). Correlation and multivariate linear regression analysis were used to determine the association and strength of variables to predict proteinuria. Proteinuria was defined as 24HUP ≥0.300g and impaired renal filtration function as creatinine clearance (ClCr) proteinuria in this study. The risk factors of proteinuria in subjects without impaired renal filtration function in Owerri, Nigeria, included 24HUV, SUPCR, 24HUPCR, 24HUPOR, 24HUCOR and SUPOR. Further research should explore the relationship between urine creatinine and urine osmolality, and how this relationship may affect progression of kidney damage, with or without impaired renal filtration function.

  18. Detecting reduced renal function in children

    DEFF Research Database (Denmark)

    Andersen, Trine Borup; Jødal, Lars; Erlandsen, Erland J

    2013-01-01

    Background The aim of this study was to compare the ability of renal indicators [serum creatinine (SCr), cystatin C (SCysC)] and glomerular filtration rate (GFR)-models to discriminate normal and reduced renal function. As a single cut-off level will always lead to false classifications, we propose...... function was defined as a GFR ofmodels were compared for their ability to correctly classify renal function as normal or reduced. Cut-off levels were determined so as to give 99 % certainty outside the gray zone...... using two cut-off levels, dividing renal function into normal or reduced, with an intermediate "gray zone" of indeterminable results.Methods Glomerular filtration rate was measured by plasma clearance of 51Cr-EDTA (13.7–147.4 mL/min/1.73 m2) in 119 children (age range 2.3–14.9 years).Reduced renal...

  19. Estimated Glomerular Filtration Rate Trajectories in HIV-Infected Subjects Treated With Different Ritonavir-Boosted Protease Inhibitors and Tenofovir Disoproxil Fumarate or Abacavir.

    Science.gov (United States)

    Gianotti, Nicola; Galli, Laura; Poli, Andrea; Salpietro, Stefania; Nozza, Silvia; Carbone, Alessia; Merli, Marco; Ripa, Marco; Lazzarin, Adriano; Castagna, Antonella

    2016-05-01

    The aim of the study was to evaluate in human immunodeficiency virus (HIV)-infected patients estimated glomerular filtration rate (eGFR) trajectories during treatment with different protease inhibitors (PIs) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus tenofovir (TDF) or abacavir (ABC) and lamivudine or emtricitabine (xTC).Retrospective study of patients followed at a single clinical center; all patients who started TDF or ABC for the first time with a NNRTI or lopinavir/r (LPV/r) or atazanavir/r (ATV/r) or darunavir/r (DRV/r), for whom at least 1 eGFR value before the start and during the studied treatment was known, were included in this analysis. eGFR was calculated by means of the CKD-EPI formula. Univariate and multivariate mixed linear model (MLM) was applied to estimate eGFR slope with the considered antiretroviral treatment.In the 1658 patients treated with TDF/xTC (aged 43 [37-48] years, with an eGFR of 105 [96; 113] mL/min/1.73 m, 80% males, 92% Caucasians, 10% coinfected with HCV, 4% with diabetes, 11% with hypertension, 38% naive for antiretroviral therapy (ART), 37% with HIV-RNA <50 copies/mL) the median follow-up was 2.5 (1.2-4.6) years. Their adjusted eGFR slopes (95% CI) were -1.26 (-1.58; -0.95), -0.43 (-1.20; +0.33), -0.86 (-1.28; -0.44), and -0.20 (-0.42; +0.02) mL/min/1.73 m per year in patients treated with ATV/r, DRV/r, LPV/r, and NNRTI, respectively. Patients receiving ATV/r or LPV/r had a greater adjusted decline in eGFR compared with those receiving NNRTIs (difference -1.06 [-1.44; -0.69] mL/min/1.73 m per year, P <0.001; and -0.66 [-1.13; -0.20] mL/min/1.73 m per year, P = 0.005, respectively); adjusted eGFR slopes were similar in patients receiving DRV/r and in those receiving NNRTIs. Patients receiving ATV/r had a greater adjusted eGFR decline than those treated with DRV/r (difference -0.83 [-1.65; -0.02] mL/min/1.73 m per year; P = 0.04), but not than those receiving LPV/r; no significant difference was

  20. THE RENAL HANDLING OF HEMOGLOBIN

    Science.gov (United States)

    Bunn, H. Franklin; Esham, William T.; Bull, Robert W.

    1969-01-01

    The glomerular filtration of hemoglobin (α2β2) was studied under conditions in which its dissociation into αβ dimers was experimentally altered. Rats receiving hemoglobin treated with the sulfhydryl reagent bis(N-maleimidomethyl) ether (BME) showed a much lower renal excretion and prolonged plasma survival as compared with animals injected with untreated hemoglobin. Plasma disappearance was also prolonged in dogs receiving BME hemoglobin. Gel filtration data indicated that under physiological conditions, BME hemoglobin had impaired subunit dissociation. In addition, BME hemoglobin showed a very high oxygen affinity and a decreased rate of auto-oxidation. Glomerular filtration was enhanced under conditions which favor the dissociation of hemoglobin into dimers. Cat hemoglobin, which forms subunits much more extensively than canine hemoglobin, was excreted more readily by the rat kidney. The renal uptake of 59Fe hemoglobin injected intra-arterially into rabbits varied inversely with the concentration of the injected dose. PMID:5778789

  1. [Nucleotide receptors and renal function].

    Science.gov (United States)

    Jankowski, Maciej

    2014-01-01

    Kidney plays a key role in homeostasis of human body. It has heterogenic structure and is characterized by complicated vascular beds and numbers of sympathetic nerves endings. Nucleotides receptors are involved in the regulation of blood flow, a fundamental process for renal function. Plasma is filtrated in renal glomerulus and activity of nucleotides receptors located on cells of glomerular filter modifies the physi- cochemical properties of filter and affects the filtration process. Electrolytes, water and low molecular weight molecules are reabsorbed from tubular fluid or secreted into fluid in proximal and distal tubules. Glomerular filtration rate and activity of tubular processes are regulated via nucleotides receptors by glomerulotubularbalance and tubuloglomerular feedback. Nucleotides receptors are involved in systemic regulation of blood pressure and carbohydrate metabolism.

  2. Four hour creatinine clearance is better than plasma creatinine for monitoring renal function in critically ill patients

    OpenAIRE

    Pickering, John W.; Frampton, Christopher M; Walker, Robert J; Shaw, Geoffrey M; Endre, Zoltán H

    2012-01-01

    Introduction Acute kidney injury (AKI) diagnosis is based on an increase in plasma creatinine, which is a slowly changing surrogate of decreased glomerular filtration rate. We investigated whether serial creatinine clearance, a direct measure of the glomerular filtration rate, provided more timely and accurate information on renal function than serial plasma creatinine in critically ill patients. Methods Serial plasma creatinine and 4-hour creatinine clearance were measured 12-hourly for 24 h...

  3. Monitoring renal function in children with Fabry disease: comparisons of measured and creatinine-based estimated glomerular filtration rate

    NARCIS (Netherlands)

    C. Tondel; U. Ramaswami; K.M. Aakre; F. Wijburg; M. Bouwman; E. Svarstad

    2010-01-01

    Methods. Eighty-two examinations were done in 42 children (24 boys, 18 girls) with Fabry disease from three different centres. The mean age was 12.3 years. GFR was measured with iohexol, Cr-51-EDTA or iothalamate, and the mean mGFR was 108 ml/min/1.73 m(2). Results. The widely used original Schwartz

  4. Insulin induces the correlation between renal blood flow and glomerular filtration rate in diabetes: implications for mechanisms causing hyperfiltration

    National Research Council Canada - National Science Library

    Pihl, Liselotte; Persson, Patrik; Fasching, Angelica; Hansell, Peter; DiBona, Gerald F; Palm, Fredrik

    2012-01-01

    .... This may relate to the use of a lower streptozotocin dose, which produces a degree of hyperglycemia, which is manageable without supplemental suboptimal insulin administration, as has been used by other investigators...

  5. Indomethacin reduces glomerular and tubular damage markers but not renal inflammation in chronic kidney disease patients: a post-hoc analysis.

    Science.gov (United States)

    de Borst, Martin H; Nauta, Ferdau L; Vogt, Liffert; Laverman, Gozewijn D; Gansevoort, Ron T; Navis, Gerjan

    2012-01-01

    Under specific conditions non-steroidal anti-inflammatory drugs (NSAIDs) may be used to lower therapy-resistant proteinuria. The potentially beneficial anti-proteinuric, tubulo-protective, and anti-inflammatory effects of NSAIDs may be offset by an increased risk of (renal) side effects. We investigated the effect of indomethacin on urinary markers of glomerular and tubular damage and renal inflammation. We performed a post-hoc analysis of a prospective open-label crossover study in chronic kidney disease patients (n = 12) with mild renal function impairment and stable residual proteinuria of 4.7±4.1 g/d. After a wash-out period of six wks without any RAAS blocking agents or other therapy to lower proteinuria (untreated proteinuria (UP)), patients subsequently received indomethacin 75 mg BID for 4 wks (NSAID). Healthy subjects (n = 10) screened for kidney donation served as controls. Urine and plasma levels of total IgG, IgG4, KIM-1, beta-2-microglobulin, H-FABP, MCP-1 and NGAL were determined using ELISA. Following NSAID treatment, 24 h -urinary excretion of glomerular and proximal tubular damage markers was reduced in comparison with the period without anti-proteinuric treatment (total IgG: UP 131[38-513] vs NSAID 38[17-218] mg/24 h, pglomerulo- and tubulo-protective effects as observed outweigh the possible side-effects of NSAID treatment on the long term.

  6. The Renal Renin-Angiotensin System

    Science.gov (United States)

    Harrison-Bernard, Lisa M.

    2009-01-01

    The renin-angiotensin system (RAS) is a critical regulator of sodium balance, extracellular fluid volume, vascular resistance, and, ultimately, arterial blood pressure. In the kidney, angiotensin II exerts its effects to conserve salt and water through a combination of the hemodynamic control of renal blood flow and glomerular filtration rate and…

  7. In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients.

    Science.gov (United States)

    Sasse, Michael; Dziuba, Friederike; Jack, Thomas; Köditz, Harald; Kaussen, Torsten; Bertram, Harald; Beerbaum, Philipp; Boehne, Martin

    2015-08-01

    Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to systemic inflammatory response syndrome (SIRS) with concomitant organ malfunction. Infused particles may exacerbate inflammatory syndromes since they activate the coagulation cascade and alter inflammatory response or microvascular perfusion. In a randomized, controlled, prospective trial, we have previously shown that particle-retentive in-line filtration prevented major complications in critically ill children. Now, we investigated the effect of in-line filtration on major complications in the subgroup of cardiac patients. Children admitted to tertiary pediatric intensive care unit were randomized to either control or filter group obtaining in-line filtration throughout complete infusion therapy. Risk differences and 95 % confidence intervals (CI) of several complications such as SIRS, sepsis, mortality, various organ failure and dysfunction were compared between both groups using the Wald method. 305 children (n = 150 control, n = 155 filter group) with cardiac diseases were finally analyzed. The majority was admitted after cardiac surgery with CPB. Risk of SIRS (-11.3 %; 95 % CI -21.8 to -0.5 %), renal (-10.0 %; 95 % CI -17.0 to -3.0 %) and hematologic (-8.1 %; 95 % CI -14.2 to -0.2 %) dysfunction were significantly decreased within the filter group. No risk differences were demonstrated for occurrence of sepsis, any other organ failure or dysfunctions between both groups. Infused particles might aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction in pediatric cardiac intensive care patients. Particle-retentive in-line filtration might be effective in preventing SIRS and maintaining renal and hematologic function. In-line filtration offers a novel therapeutic option to decrease morbidity in cardiac intensive care.

  8. Renal effects of methoxyverapamil in anesthetized rats.

    Science.gov (United States)

    Brown, B; Churchill, P

    1983-05-01

    The purpose of these experiments was to determine the renal effects of methoxyverapamil (D-600). Three groups of rats were anesthetized with sodium pentobarbital and given 0, 0.85 or 1.69 nmol/min of methoxyverapamil i.v. Increases in urine flow and Na, K and Ca excretory rates occurred, in an apparently dose-dependent manner. Plasma Na and arterial renin concentration decreased at both doses and, at the higher dose, mean arterial blood pressure and effective renal plasma flow decreased while plasma K increased. Plasma Ca, glomerular filtration rate, filtration fraction and total renal plasma flow were not affected. The findings that methoxyverapamil increased urine flow and electrolyte excretion without changing glomerular filtration rate are consistent with the hypothesis that methoxyverapamil acts directly on tubular reabsorptive mechanisms. These effects, and the effect on plasma renin concentration, could contribute to the beneficial effects of this and other Ca entry antagonists in the treatment of hypertension.

  9. Clinical study of the new intelligent determination and analysis system for glomerular filtration rate%数字化智能检测分析系统测定肾小球滤过率的临床研究

    Institute of Scientific and Technical Information of China (English)

    曾昭球; 吴锡信

    2011-01-01

    Objective To discuss the clinical application value of determining glomerular filtration rate (GFR)with the new intelligent determination and analysis system for GFR(B&G System).Methods GFR of 216 hospitalized patients suffering from the different diseases was determined accurately by clearance rate of 99mTc-diethylene triamine pentoacetic acid(99mTc-DTPA)(Tc-GFR),and the serum creatinine(SCr)and blood urea nitrogen(BUN)were also determined.At the same time GFR was determined by B&G system and Robert formula(B&G-GFR,Robert-GFR),and creatinine clearance rate(CCr)and GFR were calculated by Cockcroft/Gault formula(CG-CCr-GFR).All the results were compared,and correlation analysis was done for the three groups of data.Results Among 216 patients,B&G-GFR and Tc-GFR in 106 patients with renal insufficiency and 110 patients with normal renal function showed no significant (P0.05),而Robert-GFR(ml·min-1·1.73 m-2:21.45±15.67、93.54±30.01)、CG-CCr-GFR(ml·min-1·1.73 m-2:11.87±8.69、86.27±21.44)均明显低于Tc-GFR (P<0.05或P<0.01).肾功能不全组B&G-GFR、Robert-GFR、CG-CCr-GFR与Tc-GFR差值绝对值(ml·min-1·1.73 m-2:6.15±14.07、13.83±11.36、23.41±24.34)均明显低于肾功能正常组(7.65±6.54、24.94±13.24、32.21±21.81,均P<0.05).两组B&G-GFR、Robert-GFR、CG-CCr-GFR与Tc-GFR 均呈正相关(P<0.05或P<0.01),与SCr均呈负相关(P<0.05或P<0.01).结论 B&G-GFR、RobertGFR、CG-CCr-GFR均能在一定程度上准确反映GFR,而以B&G-GFR更准确,可代替Tc-GFR应用于临床.B&G系统较其他GFR检测方法具有更准确、简便、快速、安全而廉价的优势,值得临床推广应用.

  10. Crosstalk in glomerular injury and repair

    DEFF Research Database (Denmark)

    Dimke, Henrik; Maezawa, Yoshiro; Quaggin, Susan E

    2015-01-01

    PURPOSE OF REVIEW: The glomerulus is a unique structure required for filtration of blood, while retaining plasma proteins based on size and charge selectivity. Distinct cell types form the structural unit that creates the filtration barrier. Structurally, fenestrated endothelial cells line the ca...... the glomerular filtration unit. We will highlight recent findings of cellular crosstalk via signaling pathways that regulate glomerular barrier function in pathophysiological conditions....

  11. PROTEINURIA - A RISK FACTOR FOR PREGNANCY-RELATED RENAL-FUNCTION DECLINE IN PRIMARY GLOMERULAR-DISEASE

    NARCIS (Netherlands)

    HEMMELDER, MH; DEZEEUW, D; FIDLER, [No Value; DEJONG, PE

    1995-01-01

    Pregnancy may be followed by a postpartum acceleration of renal function loss in patients with renal disease. We retrospectively analyzed the effects of pregnancy on progressive renal function decline, and the risk factors for an acceleration, in a group of 19 renal disease patients with 30 pregnanc

  12. Renal function after unilateral nephrectomy for Wilms' tumour : The influence of radiation therapy

    NARCIS (Netherlands)

    deGraaf, SSN; vanGent, H; ReitsmaBierens, WCC; vanLuyk, WHJ; Dolsma, WV; Postma, A

    1996-01-01

    The effect of therapy on renal function after unilateral nephrectomy for Wilms' tumour was studied. In the second year following unilateral nephrectomy, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated simultaneously by measuring I-125-iothalamate clearance and

  13. Safety in glomerular numbers.

    NARCIS (Netherlands)

    Schreuder, M.F.

    2012-01-01

    A low nephron number is, according to Brenner's hyperfiltration hypothesis, associated with hypertension, glomerular damage and proteinuria, and starts a vicious cycle that ends in renal failure over the long term. Nephron endowment is set during foetal life, and there is no formation of nephrons

  14. A high-powered view of the filtration barrier.

    Science.gov (United States)

    Peti-Peterdi, János; Sipos, Arnold

    2010-11-01

    Multiphoton excitation fluorescence microscopy is a powerful noninvasive imaging technique for the deep optical sectioning of living tissues. Its application in several intact tissues is a significant advance in our understanding of organ function, including renal pathophysiological mechanisms. The glomerulus, the filtering unit in the kidney, is one good example of a relatively inaccessible and complex structure, with cell types that are otherwise difficult to study at high resolution in their native environment. In this article, we address the application, advantages, and limitations of this imaging technology for the study of the glomerular filtration barrier and the controversy it recently generated regarding the glomerular filtration of macromolecules. More advanced and accurate multiphoton determinations of the glomerular sieving coefficient that are presented here dismiss previous claims on the filtration of nephrotic levels of albumin. The sieving coefficient of 70-kD dextran was found to be around 0.001. Using a model of focal segmental glomerulosclerosis, increased filtration barrier permeability is restricted only to areas of podocyte damage, consistent with the generally accepted role of podocytes and the glomerular origin of albuminuria. Time-lapse imaging provides new details and important in vivo confirmation of the dynamics of podocyte movement, shedding, replacement, and the role of the parietal epithelial cells and Bowman's capsule in the pathology of glomerulosclerosis.

  15. Association of estimated glomerular filtration rate with SYNTAX score in old patients with coronary heart disease%老年冠心病患者估计肾小球滤过率与SYNTAX积分的相关性

    Institute of Scientific and Technical Information of China (English)

    俞鑫; 孙宇姣; 齐国先

    2016-01-01

    Objective To explore the association between estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C and the SYNTAX score in old patients with coronary heart disease. Methods Two hundred and fifty-six consecutive old patients with coronary heart disease were included in this study. The patients were angiographically diagnosed with coronary heart disease between January 2013 and April 2014 at the Department of Cardiology.eGFR was caculated by using BIS2 equation based on creatinine and cystatin C.SYNTAX score was caculated by SYNTAX score algorithm. Multiple linear regression and ordinal logsitic regreesion was used to analyze the association between eGFR and SYNTAX score. Results In patients with normal of renal function [eGFR≥90 ml/(min·1.73 m2), 110 patients], mild renal insufficiency [60 ml/(min · 1.73 m2) ≤ eGFR<90 ml/(min · 1.73 m2), 98 patients], midrange and severe renal insufficiency[eGFR<60 ml/(min · 1.73 m2), 48 patients], with the decrease in renal function of patients, SYNTAX score increased: (15.42 ± 9.65), (25.24 ± 8.34), (33.73 ± 10.15) scores, P<0.01. eGFR was an independent predictor of SYNTAX score (r=-0.059, P<0.01).eGFR was negatively correlated with SYNTAX score (r=-0.457, P<0.01). Conclusions eGFR is an independent predictor of SYNTAX score and negatively correlated with SYNTAX score in old patients with coronary heart disease. This might be helpful to explain the increased risk of coronary heart disease events and mortality in old patients with renal dysfunction.%目的:探讨在老年冠心病患者中由血清胱抑素C联合血肌酐计算的估计肾小球滤过率(eGFR)与SYNTAX积分的关系。方法连续选取行冠状动脉造影检查的老年冠心病患者256例,通过以血清肌酐和胱抑素C为基础的BIS-2方程计算eGFR,并计算SYNTAX积分。应用多元线性回归分析各临床资料与SYNTAX积分之间的关联,应用有序的Logistic回

  16. CKD-EPI方程估算肾小球滤过率的评价%Assessment of CKD-EPI equation for estimating glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    王宏斌; 夏先考; 吴建华

    2011-01-01

    Objective To compare the applicability of CKD-EPI equation with MDRD equation in predicting glomerular filtration rate(GFR)in patients with chronic kidney disease(CKD) and healthy controls, and the relative risk factor of the decrease of GFR was analyzed by CKD-EPI equation. Methods GFR of 91 cases of hospitalized patients with CKD and 198 cases of healthy controls were estimated by CKD-FPI and MDRD equation respectively[denoted as GFR( CKD-EPI) and GFR( MDRD) ]. Correlation and consistency between GFR (CKD-FPI) and GFR ( MDRD) were analyzed by Person correlation analysis and Bland-Altman analytic process. CKD stage of subj ects was assessed according to GFR( MDRD) . Scr, GFR( MDRD) and GFR(CKDEPI) of each stage were compared. Correlation between GFR(CKD-FPI) and other items were also analyzed. Results There was no significant difference of age,Scr,GFR(MDRD)and GFR(CKDEPI) between male an female group(P<O. 05). There was fine correlation between GFR ( MDRD) and GFR( CKD-FPI) [GFR( MDRD) = 0. 944×GFR( CKD-FPI) +0. 612 , r2 = 0. 960 ( P<O. 001) ]. BlandAltman analytic process indicated that there was fine consistency between GFR( MDRD) and GFR(CKD-EPI). All subjects were classified into 5 CKD stages according to GFR(MDRD). Compared with GFR( MDRD) ,.mean of GFR(CKD-EPI) in CKD Ⅰ、 Ⅱ、Ⅲ stage increased 0. 15,7. 34 and l. 60 mL. min-1 . (1. 73 m2 )-1 respectively, mean of GFR(CKD-FPI) in CKD Ⅳ、Ⅴ stage decreased 0. 25 and 0. 41 mL. min-1 ( 1. 73 m2) -1 respectively. GFR ( CKD-EPI) was negatively correlative to age , systolic blood pressure ( SBP) , diastolic blood pressure( DBP) ,serum creatinine( Scr) , serum uric acid( SUA) , fasting blood glucose( FBG) , urine protein( UP) and urine protein-to-creatinine ratio( UP/Ucr) , was positively correlative to total cholesterol( TC) and urine uric acid ( P<O. 05) , but was not correlative to gender and triglyceride(P>O. 05). Conclusion The application of CKD-FPI equation to estimate GFR could reduce

  17. 碳酸锂治疗的躁狂发作患者血锂浓度与肾小球滤过率的关系%The relationship between blood lithium concentration and glomerular filtration rate in patients with manic episode receiving lithium treatment

    Institute of Scientific and Technical Information of China (English)

    汪莉; 徐乐平; 潘圆圆; 纪菊英; 陈琪; 孙剑

    2011-01-01

    Objective To explore the relationship between lithium metabolism and glomerular filtration rates ( GFR ) in manic patients. Methods Fifty two inpatients with manic episode were recruited. The serum creatinine( Scr ),blood urea nitrogen( BUN ),body surface area and plasma sodium concentration were assessed before the administration of lithium. The estimated glomerular filtration rates ( eGFR ) were calculated from the modification of diet in renal disease ( MDRD ) equation. The blood lithium concentration was measured in patients receiving lithium at 1.0 g/d for ahout one week when lithium reached the homeostasis. Correlations between blood lithium concentration and parameters mentioned above were studied. Results The blood lithium concentration was 0.2 ~ 1.0( 0.52±0.18 )mmoL/L. Single factor analysis showed that blood lithium concentration was negatively correlated with body surface area( r=-0.33,P=0.02 )and eGFR ( r=-0.30, P=0.03 ). Multiple stepwise linear regression analysis also revealed a significant inverse relation between blood lithium concentration and hody surface area( β =-0.31,P=0.02 ), eGFR( p =-0.28,P=0.03 ). But no correlations were observed between blood lithium concentration and Scr, BUN( P > 0.05 ). Conclusions Blood lithium concentration is negatively associated with eGFR, suggesting that eGFR may be used as a a predictor to evaluate lithium metabolic ability.%目的 探讨锂盐代谢与肾小球滤过率的关系.方法 收集52例接受碳酸锂治疗的躁狂发作患者,检测治疗前血肌酐、尿素氮、体表面积、血钠浓度等指标,同时根据肾脏病膳食改善(the modification of diet in renal disease,MDRD)方程估算肾小球滤过率(estimated glomerular filtration rates,eGFR);在给予口服碳酸锂1.0 g/d 1周后测定稳态血锂浓度.对上述各项指标与血锂浓度进行相关分析.结果 患者组的稳态血锂浓度为0.2~1.0 mmoL/L,平均(0.52±0.18)mmoL/L.单因素分析显示,血锂浓度与

  18. 静脉肾盂造影未显影的肾脏行99Tcm-喷替酸盐肾动态显像检测GFR价值%Determination of glomerular filtration rate by 99Tcm-DTPA nephro-dynamic imaging in patients with nonvisualization in intravenous pyelography

    Institute of Scientific and Technical Information of China (English)

    孙志勇; 张秉鸿; 王庆旭; 黄之杰; 陈新敏; 孟宪; 陈建中

    2011-01-01

    目的 泌尿系疾病患者行常规的静脉肾盂造影(IVP)检查结果为肾不显影时,进一步行肾动态显像来定量测定肾小球滤过率(glomerular filtration rate,GFR)的意义.方法 将研究对象分为3组:IVP不显影组为76例(37例左肾,39例右肾),其IVP检查为单侧肾脏肾盏肾盂及输尿管不显影,正常对照组为57例肾移植供体,阳性对照组为12例肾功能不全尿毒症期患者,均采用锝-99m-喷替酸盐(99Tcm-DTPA)肾动态显像Gates法计算其GFR,并通过多个独立样本的非参数秩和检验进行统计分析.结果 IVP不显影组中,左肾GFR为:(18.73±9.33)ml/(min·1.73 m2),右肾GFR值为:(16.71±7.02)ml/(min·1.73 m2);正常对照组左肾GFR值为:(43.41±7.40)ml/(min·1.73 m2),右肾GFR值为:(45.37±8.07)ml/(min·1.73 m2);阳性对照组GFR值为:左肾GFR值为:(6.84±3.81)ml/(min·1.73 m2),右肾GFR值为:(7.08±4.75)ml/(min·1.73 m2);3组间存在显著性差异(P<0.01).结论 IVP检查结果为肾不显影时,仍然需要进一步行肾动态显像来定量其单侧GFR,这对临床治疗决策具有指导意义.%Objective To investigate the significance of detection of the glomerular filtration rate( GFR )by 99Tcm_ diethylenetriaminepentaacetic acid( DTPA ) nephro - dynamic imaging in patients with nonvisualization in routine intravenous pyelography( IVP ). Methods Subjects were classified into three groups: IVP - nonvisualization group including 76 patients with unilateral pelvicaliceal and ureteral nonvisualization, normal control group including 57 renal transplant donors, and positive control group including 12 uremic patients with renal inadequacy. GFR was measured by 99Tcm- DTPA nephro - dynamic imaging and statistically analyzed by multiple - independent - sample nonparametric rank test. Results The GFRs of left kidneys and right kidneys in IVP group were( 18.73±9.33 )and( 16.71±7.02 )ml/( min · 1.73 m2 ), respectively. In the normal control group those were ( 43.41±7

  19. Indomethacin reduces glomerular and tubular damage markers but not renal inflammation in chronic kidney disease patients: a post-hoc analysis.

    Directory of Open Access Journals (Sweden)

    Martin H de Borst

    Full Text Available Under specific conditions non-steroidal anti-inflammatory drugs (NSAIDs may be used to lower therapy-resistant proteinuria. The potentially beneficial anti-proteinuric, tubulo-protective, and anti-inflammatory effects of NSAIDs may be offset by an increased risk of (renal side effects. We investigated the effect of indomethacin on urinary markers of glomerular and tubular damage and renal inflammation. We performed a post-hoc analysis of a prospective open-label crossover study in chronic kidney disease patients (n = 12 with mild renal function impairment and stable residual proteinuria of 4.7±4.1 g/d. After a wash-out period of six wks without any RAAS blocking agents or other therapy to lower proteinuria (untreated proteinuria (UP, patients subsequently received indomethacin 75 mg BID for 4 wks (NSAID. Healthy subjects (n = 10 screened for kidney donation served as controls. Urine and plasma levels of total IgG, IgG4, KIM-1, beta-2-microglobulin, H-FABP, MCP-1 and NGAL were determined using ELISA. Following NSAID treatment, 24 h -urinary excretion of glomerular and proximal tubular damage markers was reduced in comparison with the period without anti-proteinuric treatment (total IgG: UP 131[38-513] vs NSAID 38[17-218] mg/24 h, p<0.01; IgG4: 50[16-68] vs 10[1-38] mg/24 h, p<0.001; beta-2-microglobulin: 200[55-404] vs 50[28-110] ug/24 h, p = 0.03; KIM-1: 9[5]-[14] vs 5[2]-[9] ug/24 h, p = 0.01. Fractional excretions of these damage markers were also reduced by NSAID. The distal tubular marker H-FABP showed a trend to reduction following NSAID treatment. Surprisingly, NSAID treatment did not reduce urinary excretion of the inflammation markers MCP-1 and NGAL, but did reduce plasma MCP-1 levels, resulting in an increased fractional MCP-1 excretion. In conclusion, the anti-proteinuric effect of indomethacin is associated with reduced urinary excretion of glomerular and tubular damage markers, but not with reduced excretion of renal

  20. Mortality rates across 25-hydroxyvitamin D (25[OH]D levels among adults with and without estimated glomerular filtration rate <60 ml/min/1.73 m2: the third national health and nutrition examination survey.

    Directory of Open Access Journals (Sweden)

    Holly Kramer

    Full Text Available BACKGROUND: Previous studies exploring the association between 25[OH]D levels and mortality in adults with and without kidney disease utilized 25[OH]D thresholds that have recently been scrutinized by the Institute of Medicine Committee to Review Dietary References Intakes for Vitamin D and Calcium. OBJECTIVE: We explored all-cause mortality rates across the spectrum of 25[OH]D levels over an eighteen-year follow-up among adults with and without an estimated glomerular filtration rate (eGFR 20 ng/ml after adjustment for all covariates. CONCLUSIONS: Regardless of presence of eGFR <60 ml/min/1.73 m(2, mortality rates across groups with 25[OH]D levels 20-40 ng/ml are similar.

  1. 成年健康个体肾小球滤过率正常范围的研究%The normal range of Glomerular Filtration Rate in Chinese apparently healthy adults

    Institute of Scientific and Technical Information of China (English)

    马迎春; 左力; 陈亮; 宿志梅; 孟申; 张春丽; 王海燕

    2011-01-01

    目的 探讨成年健康个体肾小球滤过率(GFR)的正常范围.方法 收集不同地域的成年健康个体,以双血浆法锝-二乙三胺五乙酸(Tc-DTPA)血浆清除率为GFR参考值(rGFR).结果 入选健康个体301名.50岁之前rGFR保持恒定;50岁之后rGFR平均每10年下降12.2 ml/min.50岁之前女性的rGFR高于男性;>50岁之后,女性的rGFR均低于男性,但差异无显著性(P>0.05).结论 50岁以后,成年健康个体GFR真实值随着年龄的增加逐渐下降;50岁之前,女性GFR平均值高于男性.%Objectives Studies show that Glomerular Filtration Rate(GFR) decrease with the increase of age, but the normal reference range of GFR by age groups in healthy Chinese adults is still unknown. The aim of this study was to investigate the normal GFR reference range by age groups in healthy Chinese adults,and to explore sex and age- related differences in GFR. Methods Three hundred and one Chinese healthy adults were enrolled. All eligible subjects were: ( 1 ) no positive finding by physical examination; (2)without any kinds of chronic disease; (3)fasting plasma glucose was normal and urinary dipstick test and sediments examination were negative. Reference GFR(rGFR) was measured using dual plasma sampling method of plasma clearance of 99mTc-DTPA. Results The normal reference of GFR kept constant with age up to 50 years, and showed a decline after the age of 50 years with the increase of age in healthy Chinese adults,the decreased average value of rGFR after the age of 50 years was 12.2 ml/min/l0 years(P<0.001 compared with those of age up to 50 years). In the age of 18to 49 years old,the mean GFR values of females was higher than those of males ( P < 0. 05 in the age 18 to 29, without significant difference in the age 30 to49) ;after the age of 50,the mean GFR values of female was lower than those of male,but without significant difference. Conclusions We firstly report of the reference GFR range and sex- and age- related

  2. The single-plasma-sample method for determining the glomerular filtration rate with Tc-99m-diethylenetriamine pentaacetic acid in childhood and adolescence. Is it age-dependent?

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Kazuo [JR Sapporo General Hospital (Japan); Matsuyama, Takeshi [Tokyo Metropolitan National Health Insurance Organization Fussa Hospital (Japan)

    2002-12-01

    The aim of this study is to assess the accuracy of the pre-existing single-plasma-sample method (SPSM) to measure the glomerular filtration rate (GFR) with Tc-99m-diethylenetriamine pentaacetic acid (Tc-99m-DTPA) in children and adolescents. In addition, the age-independent SPSM is evaluated with two algorithms (Bubeck and Russell) applied for Tc-99m-mercaptoacetyltriglycine (Tc-99m-MAG3) SPSM. The study was performed on 14 patients (12 men and 2 women; age range 3 to 19 yr) with renal diseases. Tc-99m-DTPA (5 MBq/kg) was injected intravenously and thereafter blood samples were taken at 5, 15, 60, 90, 120, 150 and 180 min via the indwelling tube. Radioactivity in the injection syringe and plasma was measured by means of a double-well single-plastic scintillation counter. The true'' GFR as a reference was determined by two methods: 2-exponential curve fitting 7 samples (GFR{sub 7}) and 1-exponential curve fitting 3 samples between 90 and 150 min (GFR{sub 3}) in a slow clearance phase. The GFR{sub 7} and GFR{sub 3} were searched for to the clearance (GFR{sub 1}) estimated from a plasma concentration at various sample times by means of 3 equations designed for children (Groth and Aasted, Ham-I and -II) and 3 for adults (Christensen and Groth, Jacobsson, Itoh). All the SPSM showed close correlations (r>0.95) with the reference methods. Among them, Jacobsson's equation at sample time=120 min tended to be the most accurate (r=0.9826, root mean squared error (RMSE)=7.8 ml/min). On the other hand, Ham-I's equation at sample time=120 min was the most accurate, when it was referred to GFR{sub 3} in correction for overestimation (r=0.9951, RMSE=4.60 ml/min). The Bubeck and Russells' algorithms showed that the regression equation between the GFR{sub 7} and the estimates was different in 2 groups of adults (49 cases) and children/adolescents. Our study indicates that Jacobsson's and Christensen and Groth's equations designed for adults are

  3. Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model.

    NARCIS (Netherlands)

    Wal, W.M. van der; Noordzij, M.; Dekker, F.W.; Boeschoten, E.W.; Krediet, R.T.; Korevaar, J.C.; Geskus, R.B.

    2011-01-01

    BACKGROUND: Declining residual renal function, as indicated by the glomerular filtration rate (GFR), is associated with an increased mortality risk in patients with end-stage renal disease (ESRD) on dialysis. METHODS: We monitored GFR and mortality in 1800 haemodialysis (HD) and peritoneal dialysis

  4. Assessment of Glomerular Filtration Rate on Coronary Artery Lesions by Cockcroft_Gault Equation%Cockcroft_Gault 方程估算 GFR 对冠状动脉病变的评估

    Institute of Scientific and Technical Information of China (English)

    郑家胜; 俎德玲; 诸葛毅; 屠晓鸣; 金奇志

    2015-01-01

    目的:探讨Cockcroft_Gault方程估算肾小球滤过率与冠状动脉狭窄程度的研究。方法冠状动脉造影确定为冠心病者253例为冠心病组,以Gensini积分对冠状动脉病变程度进行评分并分级,168例冠状动脉粥样硬化狭窄程度<50%患者为对照组,通过Cockcroft_Gault方程估算两组患者的肾小球滤过率,分析冠状动脉病变与估算肾小球滤过率之间的关系。结果冠心病组与对照组的估算肾小球滤过率分别为:(61.13±11.10)[mL/(min ×1.73m2)]和(77.92±11.80)[mL/(min ×1.73m2)]( P<0.05),差异有统计学意义。冠状动脉轻度、中度和重度病变组,估算肾小球滤过率分别为(66.73±14.56)[mL/(min ×1.73m2)],(63.83±15.45)[mL/(min ×1.73m2)]和(57.23±14.37)[mL/(min ×1.73m2)],差异有统计学意义( P<0.05)。结论 Cockcroft_Gault方程估算的肾小球滤过率可作为评估冠状动脉病变的临床参考指标。%Objective To discuss the research of the relationship between estimated glomerular filtration rate by Cockcroft_Gault equa-tion and coronary artery stenosis degree in patients with coronary heart disease.Methods 253 patients with coronary heart disease were confirmed by coronary angiography as coronary heart disease group ,and were graded the degree of coronary artery lesion by Gensini score ,168 cases of patients with degree of coronary atherosclerosis stenosis <50% were selected as control group.Glomerular filtra-tion rate of the patients from two groups were estimated by Cockcroft_Gault equation ,and the relationship between coronary artery dis-ease and glomerular filtration rate were analyzed. Results The glomerular filtration rate of coronary heart disease group and control group were(61.13 ± 11.10) [mL/(min × 1.73m2 )] and (77.92 ± 11.80) [mL/(min × 1.73m2 )] ( P<0.05) respectively ,there were statistical significant differences.The glomerular filtration

  5. Glucagon-like peptide-1 does not have acute effects on central or renal hemodynamics in patients with type 2 diabetes without nephropathy

    DEFF Research Database (Denmark)

    Asmar, Ali; Simonsen, Lene; Asmar, Meena

    2016-01-01

    effects of GLP-1 in patients with type 2 diabetes under fixed sodium intake. During a 3-hour infusion of GLP-1 (1.5 pmol kg(-1) min(-1)) or saline, intra-arterial blood pressure and heart rate were measured continuously, concomitantly with cardiac output estimated by pulse contour analysis. Renal plasma...... flow, glomerular filtration rate, and uptake/release of hormones and ions were measured using Fick's Principle after catheterization of a renal vein. Urine collection was conducted throughout the experiments at voluntary voiding, and patients remained supine during the experiments. During the GLP-1...... infusion, systolic and diastolic blood pressure and cardiac output remained unchanged, whereas heart rate increased significantly. Arterio-venous gradients for GLP-1 exceeded glomerular filtrations significantly, but renal plasma flow and glomerular filtration rate as well as renal sodium and lithium...

  6. Associations of blood lead, cadmium, and mercury with estimated glomerular filtration rate in the Korean general population: Analysis of 2008-2010 Korean National Health and Nutrition Examination Survey data

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yangho [Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of); Lee, Byung-Kook, E-mail: bklee@sch.ac.kr [Institute of Environmental and Occupational Medicine, Soonchunhyang University 646 Eupnae-ri, Shinchang-myun, Asan-si, Choongnam 336-745 (Korea, Republic of)

    2012-10-15

    Introduction: The objective of this study was to evaluate associations between blood lead, cadmium, and mercury levels with estimated glomerular filtration rate in a general population of South Korean adults. Methods: This was a cross-sectional study based on data obtained in the Korean National Health and Nutrition Examination Survey (KNHANES) (2008-2010). The final analytical sample consisted of 5924 participants. Estimated glomerular filtration rate (eGFR) was calculated using the MDRD Study equation as an indicator of glomerular function. Results: In multiple linear regression analysis of log2-transformed blood lead as a continuous variable on eGFR, after adjusting for covariates including cadmium and mercury, the difference in eGFR levels associated with doubling of blood lead were -2.624 mL/min per 1.73 m Superscript-Two (95% CI: -3.803 to -1.445). In multiple linear regression analysis using quartiles of blood lead as the independent variable, the difference in eGFR levels comparing participants in the highest versus the lowest quartiles of blood lead was -3.835 mL/min per 1.73 m Superscript-Two (95% CI: -5.730 to -1.939). In a multiple linear regression analysis using blood cadmium and mercury, as continuous or categorical variables, as independent variables, neither metal was a significant predictor of eGFR. Odds ratios (ORs) and 95% CI values for reduced eGFR calculated for log2-transformed blood metals and quartiles of the three metals showed similar trends after adjustment for covariates. Discussion: In this large, representative sample of South Korean adults, elevated blood lead level was consistently associated with lower eGFR levels and with the prevalence of reduced eGFR even in blood lead levels below 10 {mu}g/dL. In conclusion, elevated blood lead level was associated with lower eGFR in a Korean general population, supporting the role of lead as a risk factor for chronic kidney disease.

  7. Oxidative stress in primary glomerular diseases

    DEFF Research Database (Denmark)

    Markan, Suchita; Kohli, Harbir Singh; Sud, Kamal;

    2008-01-01

    To evaluate the status of oxidative stress in patients with different primary glomerular diseases (PGD) which have differential predisposition to renal failure.......To evaluate the status of oxidative stress in patients with different primary glomerular diseases (PGD) which have differential predisposition to renal failure....

  8. 肾小球滤过率智能检测分析系统的研制及临床应用研究%Preparation and clinical application of an intelligent determination and analysis system for glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    吴锡信; 屈敏; 冯敏坚; 石俊; 陈江林; 彭健; 吴一武; 郑志雄

    2008-01-01

    目的 研制肾小球滤过率(GFR)智能检测分析系统(GFRBMAS),并探讨其检测GFR的临床应用价值.方法 采用VB 6.0软件编程,并配置好GFRBMAS.采用99锝m-二:乙烯三胺五乙酸(99Tcm-DTPA)清除率准确测定79例不同疾病住院患者GFR(Tc-GFR),检测并比较GFRBMAS与日立7170S全自动生化仪所测得的血清肌酐(SCr)、尿素氮(BUN)、血尿酸(Uric)、血清钙(Ca)和血清磷(P)值,同时以GFRBMAS、Robert公式测定或测算GFR(GFRBMAS-GFR、Robert-GFR),以Cockcroft/Gault公式计算内生肌酐清除率(CG-CCr),所得数据进行相关分析与对比研究.结果 两种检测方法测得的SCr、BUN、Uric、Ca、P值差异均无统计学意义(P均>0.05),且两者均呈显著正相关(P均<0.01).肾功能正常组和不全组Robert-GFR、CG-CCr值均明显小于Tc-GFR值,差异有统计学意义(P均<0.01),而GFRBMAS-GFR值与Tc-GFR值相近.相关分析显示,肾功能不全组及正常组GFRBMAS-GFR、Robert-GFR、CG-CCr与Tc-GFR值均呈显著正相关,与SCr、BUN均呈负相关(P<0.05或P<0.01).结论 GFRBMAS-GFR、Robert-GFR、CG-CCr均能在一定程度上准确反映GFR,而GFRBMAS-GFR可代替Tc-GFR应用于临床.%Objective To prepare an intelligent determination and analysis system for renal glomerular filtration rate(GFRBMAS),and to explore its value in clinical setting.Methods GFRBMAS was prepared by programming with VB 6.0 software.GFR of 79 inhospital patients suffering from the different diseases was determined accurately by using clearance rate of 99Tcm-diethylene triamine pentoacetic acid(DTPA) (Tc-GFR).The serum creatinine(SCr),blood urea nitrogen(BUN),serum uric acid(Uric),serum calcium(Ca)and serum phosphorus(P)were determined with both GFRBMAS and 7170S automatic biochemistry determination apparatus(ititachi),and the result of GFR was compared with that determined by using GFRBMAS and 7170S automatic biochemical determination apparatus.At the same time GFR was determined by using

  9. Prostacyclin Synthase: Upregulation during Renal Development and in Glomerular Disease as well as Its Constitutive Expression in Cultured Human Mesangial Cells

    Directory of Open Access Journals (Sweden)

    Thomas Klein

    2015-01-01

    Full Text Available Prostacyclin (PGI2 plays a critical role in nephrogenesis and renal physiology. However, our understanding of how prostacyclin release in the kidney is regulated remains poorly defined. We studied expression of prostacyclin synthase (PGIS in developing and adult human kidneys, and also in selected pediatric renal diseases. We also examined PGI2 formation in human mesangial cells in vitro. We observed abundant expression of PGIS in the nephrogenic cortex in humans and in situ hybridization revealed an identical pattern in mice. In the normal adult kidney, PGIS-immunoreactive protein and mRNA appear to localize to mesangial fields and endothelial and smooth muscle cells of arteries and peritubular capillaries. In kidney biopsies taken from pediatric patients, enhanced expression of PGIS-immunoreactive protein was noted mainly in endothelial cells of patients with IgA-nephropathy. Cultured human mesangial cells produce primarily PGI2 and prostaglandin E2, followed by prostaglandin F2α Cytokine stimulation increased PGI2 formation 24-fold. Under these conditions expression of PGIS mRNA and protein remained unaltered whereas mRNA for cyclooxygenase-2 was markedly induced. In contrast to its constitutive expression in vitro, renal expression of prostacyclin-synthase appears to be regulated both during development and in glomerular disease. Further research is needed to identify the factors involved in regulation of PGIS-expression.

  10. Glomerular Damage in Experimental Proliferative Glomerulonephritis Under Glomerular Capillary Hypertension

    Directory of Open Access Journals (Sweden)

    Pei-Rong Wang

    2015-03-01

    Full Text Available Background/Aims: Immunologically and hemodynamically mediated the destruction of glomerular architecture is thought to be the major causes of end-stage renal failure. The purpose of this study is to evaluate the effect of glomerular hypertension on glomerular injury and the progression of glomerular sclerosis after Thy-1 nephritis was induced. Method: Thy-1 nephritis was induced in the stroke-prone spontaneously hypertensive rat strain (SHR-SP (group SP and in age-matched Wistar-Kyoto (WKY (group WKY rats, following unilateral nephrectomy (UNX, and a vehicle was injected alone in UNX SHR-SP as control (group SC. Result: The degree of glomerular damage in response to a single dose of anti-thy-1 antibody, and its functional consequences (eg. proteinuria, diminished GFR are more pronounced in group SP than normotensive group WKY and hypertensive group SC without mesangial cell injury. While normotensive group WKY rats recovered completely from mesangial cell injury on day 28-42, glomeruli in group SP kept on persistent macrophage infiltration, α-SMA expression on day 42-56. In addition, glomerular capillary repair with the GECs was rarely seen in pronouncedly proliferative and sclerostic areas. The incidence of glomerular sclerosis and the level of proteinuria were markedly increased by day 56 in the group SP. Conclusions: Our results demonstrate that glomerular hypertension aggravate glomerular damage and glomerulosclerosis in this model of Thy 1 nephritis.

  11. An unusual case of pulmonary-renal syndrome associated with defects in type IV collagen composition and anti-glomerular basement membrane autoantibodies.

    Science.gov (United States)

    Charytan, David; MacDonald, Brian; Sugimoto, Hikaru; Pastan, Stephen; Staton, Gerald; Hennigar, Randy; Kalluri, Raghu

    2005-04-01

    Commercial serological assays for the presence of anti-glomerular basement membrane (GBM) antibodies are thought to be indicative of Goodpasture's syndrome. We report a case in which commercial tests inaccurately suggested that a patient with a pulmonary-renal syndrome had Goodpasture's disease. Additional laboratory testing using recombinant type IV collagen NC1 domain proteins showed that the autoantibodies in question were not directed against the Goodpasture antigen (the alpha3NC1 domain), but against the alpha2NC1 domain of type IV collagen. Our findings represent the first known case of human autoantibodies to the alpha2NC1 domain. Further investigation showed that this patient has decreased alpha3 and alpha5 chain expression in the GBM and defects in type IV collagen, resembling abnormalities in patients with Alport's syndrome.

  12. Rheological Influence Upon the Glomerular Podocyte and Resultant Mechanotransduction

    Directory of Open Access Journals (Sweden)

    Simona Pichler Sekulic

    2015-03-01

    Full Text Available The glomerular podocyte is exposed to numerous mechanical forces as a constituent of the glomerular filtration apparatus. This includes fluid shear stress (FSS displaced upon the podocytic foot process's apical, lateral, and basal surfaces. Even in the face of continuous flow the podocyte is capable of contributing to physiologic filtration, however with pathologic levels of hyperfiltration there is increased FSS placed upon the cell. The mechanisms by which the podocyte detects and responds to FSS are topics of recent investigations, with the aim to clarify the way these cells are injured and/or adapt in times of hyperfiltration and disease states. As the pathogenesis of numerous glomerulopathies is contingent on the status of the podocyte, understanding the manner that these cells can be modified by FSS is essential. Likewise, determination of the effect of such mechanical forces upon other resident cells of the renal corpuscle would reveal the contribution of FSS in the progression of glomerular diseases. The biochemical manner in which podocytes sense and respond to FSS, that is mechanotransduction, will be discussed.

  13. Early release of neonatal ureteral obstruction preserves renal function

    DEFF Research Database (Denmark)

    Shi, Yimin; Pedersen, Michael; Li, Chunling;

    2004-01-01

    .05) after 24 wk. Similarly, glomerular filtration rate of the obstructed kidney was severely reduced at 24 wk: 172 ± 36 vs. 306 ± 42 μl·min−1·100 g body wt−1 (P reduction in total protein content...... downregulation of Na-K-ATPase to 62 ± 7%, aquaporin-1 to 53 ± 3%, and aquaporin-3 to 53 ± 7% of sham levels. Release after 1 wk completely prevented development of hydronephrosis, reduction in RBF and glomerular filtration rate, and downregulation of renal transport proteins, whereas release after 4 wk had...

  14. Dietary fish oil reduces glomerular injury and elevated renal hydroxyeicosatetraenoic acid levels in the JCR:LA-cp rat, a model of the metabolic syndrome.

    Science.gov (United States)

    Aukema, Harold M; Lu, Jing; Borthwick, Faye; Proctor, Spencer D

    2013-07-14

    We have previously shown nutritional intervention with fish oil (n-3 PUFA) to reduce numerous complications associated with the metabolic syndrome (MetS) in the JCR:LA-corpulent (cp) rat. In the present study, we sought to explore the potential role of fish oil to prevent glomerulosclerosis in JCR:LA-cp rats via renal eicosanoid metabolism and lipidomic analysis. Male lean and MetS JCR:LA-cp rats were fed a lipid-balanced diet supplemented with fish oil (5 or 10 % of total fat). After 16 weeks of feeding, albuminuria was significantly reduced in MetS rats supplemented with 5 or 10 % fish oil ( - 53 and - 70 %, respectively, compared with the untreated MetS rats). The 5 % fish oil diet resulted in markedly lower glomerulosclerosis ( - 43 %) in MetS rats and to a lesser extent in those supplemented with 10 % fish oil. Interestingly, untreated MetS rats had higher levels of 11- and 12-hydroxyeicosatetraenoic acids (HETE) v. lean rats. Dietary fish oil reduced these levels, as well as other (5-, 9- and 15-) HETE. Whilst genotype did not alter prostanoid levels, fish oil reduced endogenous renal levels of 6-keto PGF1α (PGI2 metabolite), thromboxane B2 (TxB2), PGF2α and PGD2 by approximately 60 % in rats fed 10 % fish oil, and TxB2 ( - 50 %) and PGF2α ( - 41 %) in rats fed 5 % fish oil. In conclusion, dietary fish oil prevented glomerular damage in MetS rats and mitigated the elevation in renal HETE levels. These results suggest a potential role for dietary fish oil to improve dysfunctional renal eicosanoid metabolism associated with kidney damage during conditions of the MetS.

  15. Sinomenine alleviates high glucose-induced renal glomerular endothelial hyperpermeability by inhibiting the activation of RhoA/ROCK signaling pathway

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Qingqiao [Renal Department of Internal Medicine, The Third Hospital of Wuhan (China); Xia, Yuanyu, E-mail: xiayuanyu.wh@gmail.com [Renal Department of Internal Medicine, The Third Hospital of Wuhan (China); Wang, Guan [Department of Cardiology, The Second Affiliated Hospital of Guangzhou Medical University (China)

    2016-09-02

    As an early sign of diabetic cardiovascular disease, endothelial dysfunction may contribute to progressive diabetic nephropathy (DN). Endothelial hyperpermeability induced by hyperglycemia (HG) is a central pathogenesis for DN. Sinomenine (SIN) has strong anti-inflammatory and renal protective effects, following an unknown protective mechanism against HG-induced hyperpermeability. We herein explored the role of SIN in vitro in an HG-induced barrier dysfunction model in human renal glomerular endothelial cells (HRGECs). The cells were exposed to SIN and/or HG for 24 h, the permeability of which was significantly increased by HG. Moreover, junction protein occludin in the cell-cell junction area and its total expression in HRGECs were significantly decreased by HG. However, the dysfunction of tight junction and hyperpermeability of HRGECs were significantly reversed by SIN. Furthermore, SIN prevented HG-increased reactive oxygen species (ROS) by activating nuclear factor-E2-related factor 2 (Nrf2). Interestingly, activation of RhoA/ROCK induced by HG was reversed by SIN or ROCK inhibitor. HG-induced hyperpermeability was prevented by SIN. High ROS level, tight junction dysfunction and RhoA/ROCK activation were significantly attenuated with knockdown of Nrf2. Mediated by activation of Nrf2, SIN managed to significantly prevent HG-disrupted renal endothelial barrier function by suppressing the RhoA/ROCK signaling pathway through reducing ROS. We successfully identified a novel pathway via which SIN exerted antioxidative and renal protective functions, and provided a molecular basis for potential SIN applications in treating DN vascular disorders.

  16. Sinomenine alleviates high glucose-induced renal glomerular endothelial hyperpermeability by inhibiting the activation of RhoA/ROCK signaling pathway.

    Science.gov (United States)

    Yin, Qingqiao; Xia, Yuanyu; Wang, Guan

    2016-09-02

    As an early sign of diabetic cardiovascular disease, endothelial dysfunction may contribute to progressive diabetic nephropathy (DN). Endothelial hyperpermeability induced by hyperglycemia (HG) is a central pathogenesis for DN. Sinomenine (SIN) has strong anti-inflammatory and renal protective effects, following an unknown protective mechanism against HG-induced hyperpermeability. We herein explored the role of SIN in vitro in an HG-induced barrier dysfunction model in human renal glomerular endothelial cells (HRGECs). The cells were exposed to SIN and/or HG for 24 h, the permeability of which was significantly increased by HG. Moreover, junction protein occludin in the cell-cell junction area and its total expression in HRGECs were significantly decreased by HG. However, the dysfunction of tight junction and hyperpermeability of HRGECs were significantly reversed by SIN. Furthermore, SIN prevented HG-increased reactive oxygen species (ROS) by activating nuclear factor-E2-related factor 2 (Nrf2). Interestingly, activation of RhoA/ROCK induced by HG was reversed by SIN or ROCK inhibitor. HG-induced hyperpermeability was prevented by SIN. High ROS level, tight junction dysfunction and RhoA/ROCK activation were significantly attenuated with knockdown of Nrf2. Mediated by activation of Nrf2, SIN managed to significantly prevent HG-disrupted renal endothelial barrier function by suppressing the RhoA/ROCK signaling pathway through reducing ROS. We successfully identified a novel pathway via which SIN exerted antioxidative and renal protective functions, and provided a molecular basis for potential SIN applications in treating DN vascular disorders.

  17. Clinical application of the estimation of glomerular filtration rate in diabetes mellitus patients%糖尿病患者肾小球滤过率评估方法的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    李丽; 杨帆; 毛客自; 陆怡德

    2012-01-01

    Objective To investigate the suitable equation of glomerular filtration rate (GFR) in estimating renal function for type 2 diabetes mellitus patients,and to compare the application effects of modification of diet in renal disease (MDRD) ,reexpressed modification of diet in renal disease (rMDRD) ,chronic kidney disease epidemiology collaboration (CKD-EPI) and cystatin C(Cys C)-based equations for GFR. Methods Clinical data from 178 type 2 diabetes mellitus patients were collected for the detection of serum creatinine ( SCr) level,Cys C level and renal clearance of 99mTc-diethylenetriamine pentaacetic acid-deoxyglucose ( 99mTo-DTPA) which was used as the reference of isotopic GFR (iGFR). According to the standard of the American Diabetes Association (ADA) ,the 178 patients were classified into 3 groups [ GFR: 15-59,60-89 and ≥ 90 mL/( min · 1. 73 m2 ) ]. The equations for estimated GFR (eGFR) were compared with iGFR by paired t test,linear analysis,Bland and Altaian procedures ,receiver operating characteristic ( ROC) curves and 15% ,30% and 50% coincidences. Results When GFR < 60 miy( min · 1.73 m ) ,there was no significant difference between eGFR and iGFR in MDRD equation ,but when GFR ≥ 60mL/ (min·1.73 m ),there was significant difference (P < 0. 001). There was no significant difference of eGFR for rMDRD equation in accuracy and diagnostic sensitivity . When GFR ≥ 90 mL/(min·1.73 m ) ,the coincidences were higher in CKD-EPI equation than those in MDRD and rMDRD equation ,but when GFR 60-89 mL/(min·1. 73 m2 ) ,they were lower than those in Cys C GFR equation. The Cys C GFR equation had a better correlation with eGFR and iGFR,a less bias,a higher deviation and a higher coincidence than those in MDRD and rMDRD equations ,especially when GFR ≥ 90 mL/(min·1.73 m ) ,only there was no significant difference between eGFR and iGFR ,and Cys C GPR equation was better than the other 3 equations. Conclusions The 4 equations can estimate GFR accurately for type

  18. Renal function in streptozotocin-diabetic rats

    DEFF Research Database (Denmark)

    Jensen, P K; Christiansen, J S; Steven, K

    1981-01-01

    Renal function was examined with micropuncture methods in the insulin-treated streptozotocin-diabetic rat. Kidney glomerular filtration rate was significantly higher in the diabetic rats (1.21 ml/min) than in the control group (0.84 ml/min) Nephron glomerular filtration rate increased in proportion...... to the rise in kidney glomerular filtration rate (diabetic rats: 37.0 nl/min; control rats: 27.9 nl/min). Likewise renal plasma flow was significantly higher in the diabetic rats (4.1 ml/min) than in the control group (3.0 ml/min). Glomerular capillary pressure was identical in both groups (56.0 and 56.0 mm......-1mmHg-1). Kidney weight was significantly higher in the diabetic rats (1.15 g; control rats: 0.96 g) while body weight was similar in both groups (diabetic rats: 232 g; control rats: 238 g). Calculations indicate that the increases in transglomerular hydraulic pressure, renal plasma flow...

  19. Renal tubule cell repair following acute renal injury.

    Science.gov (United States)

    Humes, H D; Lake, E W; Liu, S

    1995-01-01

    Experimental data suggests the recovery of renal function after ischemic or nephrotoxic acute renal failure is due to a replicative repair process dependent upon predominantly paracrine release of growth factors. These growth factors promote renal proximal tubule cell proliferation and a differentiation phase dependent on the interaction between tubule cells and basement membrane. These insights identify the molecular basis of renal repair and ischemic and nephrotoxic acute renal failure, and may lead to potential therapeutic modalities that accelerate renal repair and lessen the morbidity and mortality associated with these renal disease processes. In this regard, there is a prominent vasoconstrictor response of the renal vasculature during the postischemic period of developing acute renal failure. The intravenous administration of pharmacologic doses of atrial natriuretic factor (ANF) in the postischemic period have proven efficacious by altering renal vascular resistance, so that renal blood flow and glomerular filtration rate improve. ANF also appears to protect renal tubular epithelial integrity and holds significant promise as a therapeutic agent in acute renal failure. Of equal or greater promise are the therapeutic interventions targeting the proliferative reparative zone during the postischemic period. The exogenous administration of epidermal growth factor or insulin-like growth factor-1 in the postischemic period have effectively decreased the degree of renal insufficiency as measured by the peak serum creatinine and has hastened renal recovery as measured by the duration of time required to return the baseline serum creatinine values. A similarly efficacious role for hepatocyte growth factor has also been recently demonstrated.

  20. Percutaneous transluminal renal angioplasty with stent is effective for blood pressure control and renal function improvement in atherosclerotic renal artery stenosis patients

    Institute of Scientific and Technical Information of China (English)

    LIAO Chuan-jun; YANG Bao-zhong; WANG Zhong-gao

    2012-01-01

    Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis.However,the decision to perform this procedure has recently raised considerable debate.The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients,especially as it relates to blood pressure control and renal function improvement.Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital.We compared blood pressure,number of oral antihypertensive medications,and renal function changes pre and post-procedure at 24 months follow-up.Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed.At 24 months follow-up,both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P <0.05).Overall,the estimated glomerular filtration rate did not change significantly (P >0.05); however,a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P <0.05).Conclusion Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients,providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.

  1. Structural determinants of glomerular permeability.

    Science.gov (United States)

    Deen, W M; Lazzara, M J; Myers, B D

    2001-10-01

    Recent progress in relating the functional properties of the glomerular capillary wall to its unique structure is reviewed. The fenestrated endothelium, glomerular basement membrane (GBM), and epithelial filtration slits form a series arrangement in which the flow diverges as it enters the GBM from the fenestrae and converges again at the filtration slits. A hydrodynamic model that combines morphometric findings with water flow data in isolated GBM has predicted overall hydraulic permeabilities that are consistent with measurements in vivo. The resistance of the GBM to water flow, which accounts for roughly half that of the capillary wall, is strongly dependent on the extent to which the GBM surfaces are blocked by cells. The spatial frequency of filtration slits is predicted to be a very important determinant of the overall hydraulic permeability, in keeping with observations in several glomerular diseases in humans. Whereas the hydraulic resistances of the cell layers and GBM are additive, the overall sieving coefficient for a macromolecule (its concentration in Bowman's space divided by that in plasma) is the product of the sieving coefficients for the individual layers. Models for macromolecule filtration reveal that the individual sieving coefficients are influenced by one another and by the filtrate velocity, requiring great care in extrapolating in vitro observations to the living animal. The size selectivity of the glomerular capillary has been shown to be determined largely by the cellular layers, rather than the GBM. Controversial findings concerning glomerular charge selectivity are reviewed, and it is concluded that there is good evidence for a role of charge in restricting the transmural movement of albumin. Also discussed is an effect of albumin that has received little attention, namely, its tendency to increase the sieving coefficients of test macromolecules via steric interactions. Among the unresolved issues are the specific contributions of the

  2. Renal phenotypic investigations of megalin-deficient patients: novel insights into tubular proteinuria and albumin filtration.

    Science.gov (United States)

    Storm, Tina; Tranebjærg, Lisbeth; Frykholm, Carina; Birn, Henrik; Verroust, Pierre J; Nevéus, Tryggve; Sundelin, Birgitta; Hertz, Jens Michael; Holmström, Gerd; Ericson, Katharina; Christensen, Erik I; Nielsen, Rikke

    2013-03-01

    The reabsorption of filtered plasma proteins, hormones and vitamins by the renal proximal tubules is vital for body homeostasis. Studies of megalin-deficient mice suggest that the large multi-ligand endocytic receptor megalin plays an essential role in this process. In humans, dysfunctional megalin causes the extremely rare Donnai-Barrow/Facio-Oculo-Acustico-Renal (DB/FOAR) syndrome characterized by a characteristic and multifaceted phenotype including low-molecular-weight proteinuria. In this study, we examined the role of megalin for tubular protein reabsorption in humans through analysis of proximal tubular function in megalin-deficient patients. Direct sequencing of the megalin-encoding gene (LRP2) was performed in a family in which three children presented with classical DB/FOAR manifestations. Renal consequences of megalin deficiency were investigated through immunohistochemical analyses of renal biopsy material and immunoblotting of urine samples. In the patients, a characteristic urinary protein profile with increased urinary excretion of vitamin D-binding protein, retinol-binding protein and albumin was associated with absence of, or reduced, proximal tubular endocytic uptake as shown by renal immunohistochemistry. In the absence of tubular uptake, urinary albumin excretion was in the micro-albuminuric range suggesting that limited amounts of albumin are filtered in human glomeruli. This study demonstrated that megalin plays an essential role for human proximal tubular protein reabsorption and suggests that only limited amounts of albumin is normally filtered in the human glomeruli. Finally, we propose that the characteristic urinary protein profile of DB/FOAR patients may be utilized as a diagnostic marker of megalin dysfunction.

  3. Role of enhanced glomerular synthesis of thromboxane A2 in progressive kidney disease.

    Science.gov (United States)

    Salvati, P; Ferti, C; Ferrario, R G; Lamberti, E; Duzzi, L; Bianchi, G; Remuzzi, G; Perico, N; Benigni, A; Braidotti, P

    1990-09-01

    Normotensive rats of the Milan strain (MNS) spontaneously develop focal glomerulosclerosis. In order to explore the contribution of glomerular thromboxane (TX) A2 synthesis to the development of the disease, we have characterized the time course of renal functional and biochemical changes, and their modification by long-term treatment with a TX-synthase inhibitor. Oral administration (150 mg.kg-1 from 1 to 14 months of age) of FCE 22178 suppressed enhanced glomerular TXB2 production at all experimental times (mean inhibition 80%) and proteinuria (varying between 27.1 and 73.0%) while preserving renal blood flow and glomerular filtration rate. These effects of TX-synthase inhibition were seen in the absence of any statistically significant changes in systemic blood pressure. Moreover, FCE 22178 had no antihypertensive effects in hypertensive rats of the Milan strain (MHS) nor in spontaneously hypertensive rats (SHR). Treatment also prevented the age-related hypoalbuminemia and hyperlipidemia observed in control MNS and significantly (P less than 0.01) reduced glomerular histologic damage, as demonstrated by light microscopy studies and measurement of sclerotic area. We conclude that: 1) MNS rats provide an animal model of long-lasting proteinuria characterized by an age-related increase in glomerular TXB2 production paralleled by progressive loss of renal structural integrity and function and by a secondary dyslipidemia; 2) pharmacological inhibition of glomerular TX-synthase attenuates the structural as well as the functional expression of kidney disease, without a primary effect on systemic blood pressure. These data are suggestive of an important modulating role of TXA2 in the progression of MNS renal disease.

  4. PERFUSION PRESSURE AND RENAL BLOOD FLOW: THEIR RELATIONSHIP AND DIFFERENCES

    Directory of Open Access Journals (Sweden)

    Carlos G. Musso, MD. PhD.1,2, Manuel Vilas, MD.

    2014-05-01

    Full Text Available The concepts of renal perfusion pressure (RPP and renal blood flow (RBF are usually confused, but although they are intimately related, they are not strictly the same. RPP originates from the minute cardiac volume and is, therefore, the cause of RBF, which generates glomerular filtration and as a consequence, also induces the urinary flow. On the other hand, whereas RPP can be subject to fluctuations, the same happens to RBF though at a much lower level due to the existence of physiological mechanisms, such as self-regulation of the flow and tubule-glomerular feed-back. We conclude that there is a dependence of the RBF in relation with RPP, with the former acting as the final responsible of the glomerular filtration.

  5. Effect of increased protein intake on renal acid load and renal hemodynamic responses.

    Science.gov (United States)

    Teunissen-Beekman, Karianna F M; Dopheide, Janneke; Geleijnse, Johanna M; Bakker, Stephan J L; Brink, Elizabeth J; de Leeuw, Peter W; van Baak, Marleen A

    2016-03-01

    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were compared in this study. Seventy-nine overweight individuals with untreated elevated blood pressure and normal kidney function were randomized to consume a mix of protein isolates (60 g/day) or maltodextrin (60 g/day) for 4 weeks in energy balance. Twenty-four-hour urinary potential renal acid load (uPRAL) was compared between groups. A subgroup (maltodextrin N = 27, protein mix N = 25) participated in extra test days investigating fasting levels and postprandial effects of meals supplemented with a moderate protein- or maltodextrin-load on glomerular filtration rate, effective renal plasma flow, plasma renin, aldosterone, pH, and bicarbonate. uPRAL was significantly higher in the protein group after 4 weeks (P ≤ 0.001). Postprandial filtration fraction decreased further after the protein-supplemented breakfast than after the maltodextrin-supplemented breakfast after 4 weeks of supplementation (P ≤ 0.001). Fasting and postprandial levels of glomerular filtration rate, effective renal plasma flow, renin, aldosterone, angiotensin-converting enzyme, pH and bicarbonate did not differ between groups. In conclusion, 4 weeks on an increased protein diet (25% of energy intake) increased renal acid load, but did not affect renal function. Postprandial changes, except for filtration fraction, also did not differ between groups. These data suggest that a moderate increase in protein intake by consumption of a protein mix for 4 weeks causes no (undesirable) effects on kidney function in overweight and obese individuals with normal kidney function.

  6. Prevalence of renal insufficiency in individuals with obesity

    OpenAIRE

    Vasiljević Nađa; Zuković Milica; Žakula Dejan; Živadinović Nenad; Žarković Boris; Živković Bojana; Zlatić Nataša; Zogović Jovana; Ležaić Višnja

    2011-01-01

    Introduction. The association of obesity with renal function disorders has been demonstrated by some studies. Objective. The aim of this study was to assess the prevalence of renal insufficiency (RI), measured as glomerular filtration rate (GFR) <60 ml/min and impact of weight loss on kidney function in a cohort of 109 obese patients (body mass index - BMI >25 kg/m2), without previous kidney disease, and who underwent the dietician’s treatment. Methods. According to body mass inde...

  7. FISIOPATOLOGÍA DE LA INSUFICIENCIA RENAL AGUDA POR CISPLATINO

    OpenAIRE

    Rodriguez Macías EL

    2013-01-01

    Cisplatin is one of the major antineoplastic used for treatment of tumors such as testicular, ovarian, cervical, lung, bladder and head, among others. It has been described various types of toxicities induced by cisplatin, but the renal is the main one. This toxicity consist sof an acute reduction in renal plasma flow and a decline in glomerular filtration and installation of a tubular necrosis, with predominant involvement of the distal tubules and accumulation of cellular debris (lumen...

  8. Effect of estimated glomerular filtration rate on plasma concentrations of B-type natriuretic peptides measured with multiple immunoassays in elderly individuals

    DEFF Research Database (Denmark)

    Schou, M.; Alehagen, U.; Goetze, J.P.

    2009-01-01

    . SETTING: 474 elderly outpatients with suspected heart failure (prevalence 13%) from the primary care. MAIN OUTCOME MEASURES: The effects of eGFR on proBNP, measured with three different immunoassays (Roche Diagnostics, Oslo and Copenhagen), and BNP (Shionogi) concentrations were evaluated by multiple......%) increase. The effect of a 10% decrease in eGFR on BNP concentrations (Shionogi) was a 10% (5% to 15%) (univariate) and a 4% (1% to 9%) (multivariate) increase. CONCLUSIONS: The effect of eGFR on proBNP measured with three different immunoassays and BNP is modest and within the same range. The effect of e......GFR on proBNP and BNP concentrations is reduced substantially after adjustment for important clinical and echocardiographic confounders. These findings should be considered before renal function is offered as an explanation for increased proBNP or BNP levels Udgivelsesdato: 2009/9...

  9. A comparison of the effect of ramipril, felodipine and placebo on glomerular filtration rate, albuminuria, blood pressure and vasoactive hormones in chronic glomerulonephritis. A randomized, prospective, double-blind, placebo-controlled study over two years.

    Science.gov (United States)

    Pedersen, E B; Bech, J N; Nielsen, C B; Kornerup, H J; Hansen, H E; Spencer, E S; Sølling, J; Jensen, K T

    1997-12-01

    The effects of an ACE-inhibitor (ramipril), a calcium antagonist (felodipine) and placebo on glomerular filtration rate (GFR), urinary albumin/creatinine ratio, blood pressure (BP) and vasoactive hormones were investigated in a randomized, prospective, double-blind, placebo-controlled study of patients with chronic glomerulonephritis and hypertension, with measurements at entrance and after 12 and 24 months. In total, 33 patients were included: 21 completed the study with 7 patients in each group. GFR was measured as 51Cr-EDTA clearance and the vasoactive hormones with radioimmunoassays. The reduction in GFR was significantly more pronounced in the felodipine group (-7 ml/min) than in the ramipril group (0 ml/min) but the same as in the placebo group (-6 ml/min). The urinary albumin/creatinine ratio was significantly more reduced in the ramipril group (-74 mg/mmol) than in the placebo group (-11 mg/mmol), which did not deviate from the felodipine group (-10 mg/mmol). BP was significantly reduced by ramipril and felodipine, but not by placebo. Angiotensin II and aldosterone in plasma increased or tended to increase in the felodipine and placebo groups, but were unchanged in the ramipril group. Endothelin increased only in the placebo group, and vasopressin, atrial natriuretic peptide, and brain natriuretic peptide were not significantly changed in any of the groups. It is concluded that ramipril seems to be superior to felodipine in chronic glomerulonephritis owing to better preservation of GFR.

  10. Effects of smoking and its cessation on creatinine- and cystatin C-based estimated glomerular filtratio