Clinical presentation of renal disease

2010 ◽  
pp. 3846-3862
Author(s):  
Richard E Fielding ◽  
Ken Farrington
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Disease ◽  
Renal Dysfunction ◽  
Filtration Rate ◽  
Clinical Signs ◽  
Underlying Disease ◽  
Clinical Suspicion ◽  
Asymptomatic Individuals ◽  
Symptoms And Signs

Renal disease may present in many ways, including: (1) the screening of asymptomatic individuals; (2) with symptoms and signs resulting from renal dysfunction; and (3) with symptoms and signs of an underlying disease, often systemic, which has resulted in renal dysfunction. History and clinical signs—in many cases these are nonspecific or not apparent, and detection of renal disease relies on a combination of clinical suspicion and simple investigations, including urinalysis (by dipstick for proteinuria and haematuria, with quantification of proteinuria most conveniently performed by estimation of the albumin:creatinine ratio, ACR, or protein:creatinine ratio, PCR) and estimation of renal function (by measurement of serum creatinine, expressed as estimated glomerular filtration rate, eGFR)....

Clinical presentation of renal disease

2020 ◽  
pp. 4764-4780
Author(s):  
Richard E. Fielding ◽  
Ken Farrington
Keyword(s):  
Renal Disease ◽  
Renal Dysfunction ◽  
Inflammatory Diseases ◽  
Clinical Signs ◽  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Chronic Depression ◽  
Drug Induced ◽  
Asymptomatic Individuals ◽  
Symptoms And Signs

Renal disease may present in many ways, including (1) the screening of asymptomatic individuals; (2) with symptoms and signs resulting from renal dysfunction; and (3) with symptoms and signs of an underlying disease, often systemic, which has resulted in renal dysfunction. History and clinical signs—in many cases these are nonspecific or not apparent, and detection of renal disease relies on a combination of clinical suspicion and simple investigations, including urinalysis and estimation of renal function. Asymptomatic renal disease—this is common and most often detected as chronic depression of eGFR (known as chronic kidney disease, CKD), proteinuria, or haematuria, either as isolated features or in combination. Symptomatic renal disease—may present in many ways, including (1) with features of severe chronic depression of glomerular filtration rate—‘uraemia’, manifesting with some or all of anorexia, nausea, vomiting, fatigue, weakness, pruritus, breathlessness, bleeding tendency, apathy and loss of mental concentration, and muscle twitching and cramps; (2) acute kidney injury (AKI); (3) with urinary symptoms—frequency, polyuria, nocturia, oliguria, anuria, and visible (macroscopic) haematuria; and (4) loin pain. Specific renal syndromes—these include (1) nephrotic syndrome—comprising oedema, proteinuria, and hypoalbuminaemia—caused by primary or secondary glomerular disease; and (2) rapidly progressive glomerulonephritis with AKI. Other conditions—renal disease may be associated with and present in the context of many underlying conditions, including (1) diabetes mellitus; (2) renovascular disease; (3) myeloma and other malignancies; (4) infectious diseases, either as a nonspecific manifestation of the sepsis syndrome or as a specific complication of the particular infection; (5) systemic inflammatory diseases; (6) drug-induced renal disease; and (7) pregnancy.

Renal Insufficiency and Failure

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 431-436 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Evangelos Terpos
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Impairment ◽  
Renal Disease ◽  
Renal Injury ◽  
Filtration Rate ◽  
Acute Renal Injury ◽  
Sustained Improvement ◽  
Definition Of

Abstract Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD (modification of diet in renal disease) formula, while RIFLE (risk, injury, failure, loss and end-stage renal disease) and AKIN (acute renal injury network) criteria may be used for the definition of the severity of acute renal injury. Novel criteria based on estimated glomerular filtration rate measurements are proposed for the definition of the reversibility of renal impairment. Renal complete response (CRrenal) is defined as sustained (i.e., lasting at least 2 months) improvement of creatinine clearance (CRCL) from under 50 mL/min at baseline to 60 mL/min or above. Renal partial response (PRrenal) is defined as sustained improvement of CRCL from under 15 mL/min at baseline to 30 to 59 mL/min. Renal minor response (MRrenal) is defined as sustained improvement of the baseline CRCL of under 15 mL/min to 15 to 29 mL/min or, if baseline CRCL was 15 to 29 mL/min, improvement to 30 to 59 mL/min. Bortezomib with high-dose dexamethasone is considered the treatment of choice for myeloma patients with renal impairment and improves renal function in most patients. Although there is limited experience with thalidomide, this agent can be administered at the standard dosage to patients with renal failure. Lenalidomide, when administered at reduced doses according to renal function, is effective and can reverse renal impairment in a subset of myeloma patients.

scholarly journals Renal Function - Estimation of Glomerular Filtration Rate

2007 ◽  
Vol 26 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Marijana Dajak ◽  
Svetlana Ignjatović ◽  
Nada Majkić-Singh
Keyword(s):  
Mass Spectrometry ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Isotope Dilution ◽  
Filtration Rate ◽  
Isotope Dilution Mass Spectrometry ◽  
Function Estimation

Funkcija Bubrega - Procena Brzine Glomerularne Filtracije Brzina glomerularne filtracije (GFR) je široko prihvaćena kao najbolja opšta mera funkcije bubrega. Vodiči američke Nacionalne fondacije za bubreg definišu hroničnu bubrežnu bolest (HBB) bilo sa vrednošću GFR koja je manja od 60 mL/min/1,73 m2 ili sa prisustvom oštećenja bubrega, bez obzira na uzrok, u toku 3 ili više meseci i klasifikuju stadijume težine HBB prema GFR. GFR se može meriti kao urinarni ili plazma klirens egzogenih filtracionih markera kao što je inulin. Međutim, zbog teškoća u primeni, troškova i radijacionog izlaganja, ove metode imaju ograničenu upotrebu u rutinskim laboratorijama. Klirens kreatinina može biti korisna alternativa kada egzogeni markeri nisu dostupni, ali sakupljanje urina u vremenskim intervalima nije pogodno za pacijente i osetljivo je na grešku pri sakupljanju. GFR se često procenjuje klinički iz serumskih koncentracija egzogenog kreatinina ili cistatina C. Cistatin C u serumu još uvek nije adekvatno procenjen kao indeks GFR, a na kreatinin u serumu utiču GFR i faktori nezavisni od GFR, uključujući godine, pol, rasu, telesnu veličinu, ishranu, izvesne lekove i laboratorijske analitičke metode. Prema kliničkim vodičima Nacionalne fondacije za bubreg, kliničke laboratorije bi trebalo da izdaju >>procenjenu<< GFR (estimated GFR), izračunatu iz prediktivnih jednačina, kao dodatak izveštavanja vrednosti markera u serumu. Trenutno preporučena jednačina za procenu je razvijena iz MDRD (Modification of Diet in Renal Disease) studije. Ova jednačina koristi godine, pol, rasu (afro-američka prema ne-afro-američkoj) i koncentraciju kreatinina u serumu, a ne zahteva varijablu za telesnu težinu zato što normalizuje GFR za standardnu telesnu površinu od 1,73 m2. Da bi se postigla poboljšana tačnost preračunate GFR sa ovom jednačinom, preporučuje se da komercijalne metode za kreatinin budu kalibrisane prema sertifikovanim referentnim materijalima i sledljive sa IDMS (isotope dilution mass spectrometry) metodologijom. Za MDRD jednačinu je pokazano da je korisna za pacijente sa HBB, ali njena upotreba je još uvek nejasna za ljude sa niskim vrednostima kreatinina u serumu i visokim vrednostima za GFR, uključujući zdrave pojedince, decu i trudnice. Validacione studije su u razvoju kako bi se procenila MDRD jednačina za druge etničke grupe i različita bolesna stanja.

scholarly journals AB0053 THE ROLE OF ANGIOPOIETIN-LIKE PROTEINS TYPES 3 AND 4 IN THE DEVELOPMENT OF RENAL DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1059.1-1059
Author(s):  
V. Aleksandrov ◽  
L. Shilova ◽  
A. Aleksandrov
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Renal Dysfunction ◽  
Filtration Rate ◽  
Serum Concentrations ◽  
Group Iii ◽  
Group I

Background:Rheumatoid arthritis (RA) often contributes to the development of kidney disease. Angiopoietin-like proteins can be target markers for studying cardiorenal complications of RA [1].Objectives:Assessment of the correlation of serum concentrations of angiopoietin-like proteins types 3 and 4 (ANGPTL 3 and 4) with the progression of renal dysfunction in RA patients.Methods:114 patients with reliable RA (90.4% of women, 9.6% of men) aged 21 to 80 years (mean age 55.4 ± 11.2 years old), disease duration - 11.18 ± 9.03 years, positive for rheumatoid factor (RF-IgM) - 63.2%, positive for anti-citrullinated protein antibody (ACPA) - 59.7%) were examined. The laboratory examination included the determination of serum concentrations of angiopoietin-like protein type 3 (Human Angiopoietin-like Protein 3 ELISA, Bio Vendor, Czech Republic) and type 4 (RayBio Human ANGPTL4 ELISA Kit; RayBiotech, USA). To assess renal function in RA patients we used the calculated glomerular filtration rate (GFR) according to the CKD-EPI formula [2], taking into account the height and weight of a particular patient without indexing by body surface area. GFR values <60 ml / min / 1.73 m2 were regarded as a certain decrease, and GFR values from 60 to 89 ml / min / 1.73 m2 - as a slight decrease in global kidney function.Results:The concentration of ANGPTL3 in the blood serum of RA patients (n = 158) was 641.9 ± 224.5 ng / ml, and that of ANGPTL4 (n = 158) - 3.15 [0.77; 12.1] ng / ml. 74.7% (n = 118) were considered positive for the presence of ANGPTL3; 49.4% (n = 78) of RA patients were recognized as positive for the presence of ANGPTL4. The average glomerular filtration rate in RA patients was 74.0 ± 18.6 ml / min. More than а half of the examined RA patients had GFR ranging from 89 to 60 ml / min / 1.73 m2 (C1 - 21.5%; C2 - 58.9%; C3 - 19.6%). No sharp reduce of renal function (GFR <30 ml / min / 1.73 m2) corresponding to CKD C4-5 stages was recorded. Negative correlations of average strength were found between GFR and the level of ANGPTL 3 (r = -0.32, p <0.001) and ANGPTL 4 (rS = -0.31, p <0.001), as well as with age (rS = -0.28, p <0.001), the duration of RA (rS = -0.22, p = 0.005) and blood pressure increase (rS = -0.25, p = 0.001). On the basis of GFR measurements, patients were divided into three groups: group I - optimal renal function (> 90 ml / min); group II - a slight decrease in renal function (89-60 ml / min); group III - reduced renal function (<59 ml / min).Table 1.Content of ANGPTL 3 and 4 in RA patients with different GFR, ng / mlGroup I (n=34)Group II (n=93)Group III (n=31)ANGPTL 3533,4±161,7 I-III650,0±223,9733,2±244,1ANGPTL 40,77 [0,28;3,6] I-II, I-III3,3 [0,93;12,1]6,48 [1,52;19,3]Note: upper case indicates intergroup differences at p <0.05.There was a significant difference in the content of ANGPTL3 in patients of the first group and the patients of the third group (H-test = 6.55, p = 0.032) and ANGPTL4 in the group of patients with normal renal function (group I) and groups of RA patients with decreased GFR (group I- II: H-test = 10.7, p = 0.001; groups I-III: H-test = 20.1, p <0.001). ANGPTL4 indices also had intergroup differences (groups II-III: H-test = 7.2, p = 0.007) with GFR less than 90 ml / min.Conclusion:Chronic rheumatoid inflammation potentiates the development of renal dysfunction according to our data in 78.5% of patients. It is also accompanied by an increase in the content of ANGPTL types 3 and 4 in the blood of RA patients. A better understanding of the actions and mechanisms of ANGPTL may be of paramount importance for the development of effective ways of treatment for cardiorenal complications in RA.References:[1]Aleksandrov A., Aleksandrov V., Shilova L. Study of the role of angiopoietin-like protein type 4 in metabolic disorders caused by inflammation in rheumatoid arthritis. Ann Rheum Dis. 2020;79(s1):1341. doi: 10.1136/annrheumdis-2020-eular.4558.[2]KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.Disclosure of Interests:None declared

scholarly journals Renal function associates with energy intake in elderly community-dwelling men

2014 ◽  
Vol 111 (12) ◽  
pp. 2184-2189 ◽  
Author(s):  
Desiree Luis ◽  
Xiaoyan Huang ◽  
Per Sjögren ◽  
Ulf Risérus ◽  
Johan Ärnlöv ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Dysfunction ◽  
Glomerular Filtration ◽  
Energy Intake ◽  
Filtration Rate ◽  
Univariate Analysis ◽  
Community Dwelling ◽  
Serum Cystatin C ◽  
Cross Sectional

Energy intake and renal function decrease with age. In patients with chronic kidney disease (CKD), spontaneous food intake decreases in parallel with the loss of renal function. The objective of the present study was to evaluate a possible relationship between renal dysfunction and energy intake in elderly community-dwelling men. A cross-sectional study including 1087 men aged 70 years from the Uppsala Longitudinal Study of Adult Men (ULSAM) community-based cohort was carried out. Dietary intake was assessed using 7 d food records, and glomerular filtration rate was estimated from serum cystatin C concentrations. Energy intake was normalised by ideal body weight, and macronutrient intake was energy-adjusted. The median normalised daily energy intake was 105 (interquartile range 88–124) kJ, and directly correlated with estimated glomerular filtration rate (eGFR) as determined by univariate analysis. Across the decreasing quartiles of eGFR, a significant trend of decreasing normalised energy intake was observed (P =0·01). A multivariable regression model including lifestyle factors and co-morbidities was used for predicting total energy intake. In this model, regular physical activity (standardised β = 0·160; P =0·008), smoking (standardised β = − 0·081; P =0·008), hypertension (standardised β = − 0·097; P =0·002), hyperlipidaemia (standardised β = − 0·064; P =0·037) and eGFR (per sd increase, standardised β = 0·064; P =0·04) were found to be independent predictors of energy intake. Individuals with manifest CKD (eGFR < 60 ml/min per 1·73 m2) were more likely to have lower energy intake than those without. In conclusion, there was a direct and independent correlation between renal function and energy intake in a population-based cohort of elderly men. We speculate on a possible link between renal dysfunction and malnutrition in the elderly.

Clinical Renal Function Testing by External Double Isotope Monitoring Technique

1971 ◽  
Vol 10 (01) ◽  
pp. 16-24
Author(s):  
J. Fog Pedersen ◽  
M. Fog Pedersen ◽  
Paul Madsen
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Plasma Flow ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Correlation Coefficients ◽  
Feedback System ◽  
Effective Renal Plasma Flow ◽  
Advantages And Disadvantages

SummaryAn accurate catheter-free technique for clinical determination simultaneouslyof glomerular filtration rate and effective renal plasma flow by means of radioisotopes has been developed. The renal function is estimated by the amount of radioisotopes necessary to maintain a constant concentration in the patient’s blood. The infusion pumps are steered by a feedback system, the pumps being automatically turned on when the radiation measured over the patient’s head falls below a certain preset level and turned off when this level is again readied. 131I-iodopyracet was used for the estimation of effective renal plasma flow and125I-iothalamate estimation of the glomerular filtration rate. These clearances were compared to the conventional bladder clearances and good correlation was found between these two clearance methods (correlation coefficients 0.97 and.90 respectively). The advantages and disadvantages of this new clearance technique are discussed.

RENAL FUNCTION AND KIDNEY SIZE FOLLOWING HYPOPHYSECTOMY IN MAN

1965 ◽  
Vol 48 (3) ◽  
pp. 348-354 ◽  
Author(s):  
Thomas Falkheden ◽  
Ingmar Wickbom
Keyword(s):  
Renal Function ◽  
Diabetic Retinopathy ◽  
Glomerular Filtration Rate ◽  
Plasma Flow ◽  
Mammary Carcinoma ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Kidney Weight ◽  
Kidney Size ◽  
Before And After

ABSTRACT Measurements of glomerular filtration rate (GFR) and renal plasma flow (RPF) were performed in close connection with roentgenographic estimation of kidney size, before and after hypophysectomy, in 10 patients (four cases of metastatic mammary carcinoma, five cases of diabetic retinopathy and one case of acromegaly). Hypophysectomy was regularly followed by a decrease in GFR and RPF. In most cases, a reduction in the roentgenographic kidney size was also observed. However, the changes in the roentgenographic kidney size and calculated kidney weight after hypophysectomy were smaller and occurred at a slower rate than the alterations in GFR and RPF. The results favour the view that, primarily, the decrease in GFR and RPF following hypophysectomy is essentially functional rather than due to a reduced kidney mass.

Early Renal Dysfunction in Obese Patients with Insulin Resistance

2019 ◽  
Vol 26 (3) ◽  
pp. 261-265
Author(s):  
Natalia Pertseva ◽  
Mariia Rokutova
Keyword(s):  
Insulin Resistance ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Filtration Rate ◽  
Diagnostic Value ◽  
Glomerular Hyperfiltration ◽  
Model Assessment ◽  
Homa Index ◽  
Obese Patients ◽  
Homeostasis Model Assessment

Abstract Background and aims. Obese individuals have insulin resistance status assessed in the present study by the HOMA index (“Homeostasis model assessment”). This prospective study assessed renal disorders in the insulin resistance in obese patients. Material and Methods. The study included 73 young obese patients. The assessment included the HOMA index before meal and parameters of renal function (glomerular filtration rate, albuminuria, β2-microglobulinuria). Results. In young obese, insulin-resistance patients, glomerular hyperfiltration and β2-microglobulinuria are found in 77.0 and 93.4% of cases respectively. The albuminuria is noted in some cases, which reduces diagnostic value. Conclusions. In young obese patients with insulin resistance, glomerular hyperfiltration and β2-microglobulinuria are main diagnostic markers of renal dysfunction.

STUDY OF RADIATION CHARACTERISTICS THE RENAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES

2014 ◽  
pp. 73-77
Author(s):  
Van Chuong Nguyen ◽  
Thi Kim Anh Nguyen
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Disease Duration ◽  
Left Kidney ◽  
Cross Sectional ◽  
The Right

Background: A Research glomerular filtration rate (GFR) of 61 patients with type 2 diabetes mellitus with renal scanning 99mTc-DTPA glomerular filtration rate at the hospital 175. Objective: (1) To study characteristics of imaging of renal function. (2) Understanding the relationship between GFR with blood sugar, HbA1c, blood pressure and albuminuria in patients with type 2 diabetes. Methods: Descriptive, prospective, cross-sectional study. Clinical examination, Clinical tests and 99mTc-DTPA GFR gamma - camera renography for patients. Result: GFR of the study group was 75,4 ± 22,3 ml/phut/1,73m2, the left kidney was 35,0 ± 13,0 is lower than the right kidney and 39,8 ± 11,9; p <0,01. There is no correlation between GFR with blood glucose and HbA1c, the risk of reduced GFR in hypertensive group associated is OR = 6,5 with p<0,01; albuminuria (+) is OR = 4,2 with p <0,01; and disease duration > 10 years is OR = 3,5 with p <0.01. Conclusion: GFR of the left kidneys is lower than the right kidney; correlation decreased GFR associated with hypertension, albuminuria and disease duration. Keywords: GFR, diabetes, albuminuria

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