Glomerular filtration rate prior to high-dose melphalan 200 mg/m2as a surrogate marker of outcome in patients with myeloma

The aim of the current study was to investigate the simultaneous measurement of plasma p-aminohippuric acid (PAH) clearance as a potential marker to assess effective renal plasma flow (eRPF) and tubular secretion (TS), and the plasma clearance of iohexol (IOH) as a marker of the glomerular filtration rate in poultry species. The PAH was administered intravenously (IV) to broiler chickens, layers, turkeys, Muscovy ducks, and pigeons. Each animal received successively a single bolus dose of 10 mg PAH/kg bodyweight (BW) and 100 mg PAH/kg BW to assess the eRPF and TS, respectively. Simultaneously with both PAH administrations, a single IV bolus of 64.7 mg/kg BW of IOH was administered. A high linear correlation (R2 = 0.79) between eRPF, based on the clearance of the low dose of PAH, and BW was observed for the poultry species. The correlation between TS, based on the clearance of the high dose of PAH, and BW was moderate (R2 = 0.50). Finally, a moderate correlation (R2 = 0.68) was demonstrated between GFR and eRPF and between GFR and TS (R2 = 0.56). This presented pharmacokinetic approach of the simultaneous administration of IOH and PAH enabled a simultaneous evaluation of eRPF/TS and GFR, respectively, in different poultry species.

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Atrial natriuretic factor increases after a protein meal in man

Clinical Science ◽

10.1042/cs0750495 ◽

1988 ◽

Vol 75 (5) ◽

pp. 495-498 ◽

Cited By ~ 9

Author(s):

Bernardo Rodríguez-Iturbe ◽

José Herrera ◽

Jolanta Gutkowska ◽

Gustavo Parra ◽

Jesús Coello

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Atrial Natriuretic Factor ◽

Filtration Rate ◽

High Dose ◽

Protein Meal ◽

Natriuretic Factor ◽

Meat Meal ◽

Carbohydrate Meal ◽

Atrial Natriuretic

1. The renal function changes induced by dietary protein are thought to result from the activity of hormonal factors that remain as yet undefined. Since a meat meal and high dose atrial natriuretic factor (ANF) infusions have similar effects on glomerular filtration rate, natriuresis and kaliuresis, we decided to investigate the possibility that a protein meal could stimulate ANF activity. 2. We studied 10 normal volunteers who had a fixed protein and sodium intake for 7 days before the experiments. The subjects received a meat meal (1–1.5 g of protein/kg) and, on a separate occasion, a carbohydrate meal that had a similar caloric, sodium and potassium content. Diuresis was stimulated with water ingestion, and urine collections were obtained before the meals (baseline) and after the meals for a period of 3 h. Blood samples were obtained 30 min and 5 min before the meals and every hour for 3 h in the period after the meal. 3. The protein meal, but not the carbohydrate meal, was associated with parallel increments in plasma immunoreactive ANF (i-ANF), natriuresis, kaliuresis and glomerular filtration rate (estimated from creatinine clearances) which reached peak values 2–3 h after the meal. The mean increment of plasma i-ANF after the protein meal represented a twofold increase over baseline levels. 4. We conclude that ANF may participate in the physiological response to an oral protein load.

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Methotrexate-induced renal impairment: clinical studies and rescue from systemic toxicity with high-dose leucovorin and thymidine.

Journal of Clinical Oncology ◽

10.1200/jco.1983.1.3.208 ◽

1983 ◽

Vol 1 (3) ◽

pp. 208-216 ◽

Cited By ~ 92

Author(s):

H T Abelson ◽

M T Fosburg ◽

G P Beardsley ◽

A M Goorin ◽

C Gorka ◽

...

Keyword(s):

Renal Failure ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Systemic Toxicity ◽

High Dose ◽

Severe Toxicity ◽

Treatment Comparison ◽

Dose Methotrexate ◽

Significant Difference

Four separate groups of patients have been studied: (1) The effect of high-dose methotrexate (MTX) administration on glomerular filtration rate was determined by pre- and posttreatment inulin and creatinine clearances in nine patients. Measurements were made prior to and 24-40 hr after drug administration. Inulin and creatinine clearances both decreased a mean of 43%. No signs of systemic toxicity occurred. (2) Three other patients given high-dose courses of MTX developed MTX toxicity. Their creatinine clearance decreased an average of 61%. (3) In a separate group of five patients undergoing weekly MTX treatment, comparison of serum MTX pharmacokinetics with and without alkalinization of the urine demonstrated no significant difference in peak serum MTX levels or serum MTX decay. (4) Eight additional patients with severe renal dysfunction secondary to MTX were treated with increased doses of leucovorin and a continuous infusion of thymidine (8 g/m2/day) once renal failure was recognized. When high-dose leucovorin and thymidine were begun 48-72 hr after the MTX infusion, severe toxicity in the form of leukopenia, thrombocytopenia, diffuse mucositis, stomatitis, or skin rash was averted. We concluded the following: (1) high-dose MTX causes a subclinical decrease in glomerular filtration rate with each administration, even in nontoxic courses; (2) alkalinization of the urine with sodium bicarbonate does not alter plasma MTX decay, while volume expansion (hydration) is maintained constant; and (3) rigorous monitoring of serum creatinine and serum MTX levels 24-48 hr after MTX administration allows for the institution of rescue measures, including leucovorin and thymidine, which will abort the systemic toxicity that accompanies MTX-induced renal failure.

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Are glomerular filtration rate estimations necessary before high dose methotrexate?

Archives of Disease in Childhood ◽

10.1136/adc.81.4.339 ◽

1999 ◽

Vol 81 (4) ◽

pp. 339-340 ◽

Cited By ~ 1

Author(s):

H Rees ◽

I M Hann ◽

J M Chessells ◽

D K H Webb

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

High Dose ◽

High Dose Methotrexate ◽

Dose Methotrexate

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P6534Prognostic implication of serum cystatin C and creatinine-based glomerular filtration rate ratio in coronary disease patients receiving PCI: a surrogate of low muscle mass and a predictor of mortality

European Heart Journal ◽

10.1093/eurheartj/ehz746.1124 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T.-M Rhee ◽

K W Park ◽

C.-H Kim ◽

J Kang ◽

J.-K Han ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Muscle Mass ◽

Cystatin C ◽

Filtration Rate ◽

Surrogate Marker ◽

Prognostic Impact ◽

Risk Of Death ◽

Body Muscle ◽

Tertiary Center

Abstract Background Low muscle mass results in impaired exercise capacity and is related with poor prognosis in chronic diseases. Although the ratio of serum creatinine (Scr) to cystatin C (Scys) is known as a surrogate marker of body muscle mass, the value of this marker is unclear in the patients with coronary artery disease (CAD). Purpose We assessed the clinical significance of two markers representing body muscle mass, the ratio of Scr to Scys (Scr/Scys), and ratio of estimated glomerular filtration rate by Scys to Scr (eGFRcys/eGFRcr). Methods We analyzed patients enrolled in a single tertiary center prospective percutaneous coronary intervention (PCI) registry that had Scr and Scys levels simultaneously measured before PCI. Optimal cut-off values of Scr/Scys and eGFRcys/eGFRcr, and their prognostic impact on 3-year mortality after PCI were analyzed. Subgroup analysis according to various demographics and risk factors was performed. Results A total of 1,928 patients who underwent PCI for significant CAD were analyzed (age 65.2±9.9 years, 70.8% men). Both Scr/Scys and eGFRcys/eGFRcr showed strong correlation with estimated proportion of muscle mass. Cut-off values of Scr/Scys discriminating 3-year death were 1.0 for men and 0.8 for women, while those of eGFRcys/eGFRcr were 1.1 for men and 1.0 for women. Both Scr/Scys- and eGFRcys/eGFRcr-based low muscle mass groups showed significantly higher risk of death, after adjusting for 7 selected covariates including age. The additional discriminative power of low muscle mass group on the predictive model was greater in the group determined by eGFRcys/eGFRcr than Scr/Scys. Low eGFRcys/eGFRcr values showed additional prognostic impact especially in patients older than 65 years, non-obese, men, chronic kidney disease, and current smokers. Conclusions Low muscle mass was an independent prognostic indicator in the patients who underwent coronary stenting. eGFRcys/eGFRcr was identified as a useful surrogate of muscle mass, which may be used to detect vulnerable patients with low muscle mass at high risk for future events. Acknowledgement/Funding None

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Effects on renal hemodynamics of intra-arterial infusions of angiotensins I and II

AJP Renal Physiology ◽

10.1152/ajprenal.1983.245.2.f181 ◽

1983 ◽

Vol 245 (2) ◽

pp. F181-F187 ◽

Cited By ~ 9

Author(s):

L. Rosivall ◽

L. G. Navar

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

High Dose ◽

Ang Ii ◽

High Sodium ◽

Proximal Tubular ◽

Anesthetized Dogs ◽

Flow Pressure ◽

Stop Flow

Experiments were conducted in anesthetized dogs to evaluate the differences between the effects of intrarenal conversion of angiotensin I (ANG I) to angiotensin II (ANG II) and those of circulating ANG II on renal blood flow (RBF), glomerular filtration rate (GFR), peritubular capillary pressure (PCP), proximal tubular free-flow pressure (PTP), and stop-flow pressure (SFP). Equiconstrictor doses of ANG I and ANG II were infused into the renal arteries of dogs kept on normal and high sodium diets. In clearance experiments, RBF decreased by 23% (low dose) and 33% (high dose) during the infusion of either ANG I or ANG II; GFR was significantly reduced only during the ANG I infusion. In micropuncture experiments, in which the GFR responses were similar, there were significant reductions in PTP (23 +/- 3%) and PCP (33 +/- 3%) during the intrarenal ANG I infusion; SFP was not altered significantly. Afferent and efferent arteriolar resistances increased significantly during ANG I infusion as well as during infusion of ANG II. These results indicate that during intra-arterial infusion of ANG I, the conversion to ANG II within the kidney occurs early enough to decrease glomerular filtration rate through an apparent increase in preglomerular resistance.

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