scholarly journals Clinical Implications of the Change in Glomerular Filtration Rate with Adrenergic Blockers in Patients with Morning Hypertension: The Japan Morning Surge-1 Study

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Seiichi Shibasaki ◽  
Kazuo Eguchi ◽  
Yoshio Matsui ◽  
Kazuyuki Shimada ◽  
Kazuomi Kario
Keyword(s):  
Glomerular Filtration Rate ◽  
Treatment Group ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Early Stage ◽  
Urinary Albumin ◽  
Control Group ◽  
Ckd Stage ◽  
Negative Effect ◽  
Morning Hypertension

Background. The aim of this study was to clarify the relationship between the change in estimated glomerular filtration rate (eGFR) and urinary albumin by antihypertensive treatment.Methods. We randomized 611 treated patients with morning hypertension into either an added treatment group, for whom doxazosin was added to the current medication, or a control group, who continued their current medications. We compared the change in eGFR and urinary albumin creatinine ratio (UACR) between the groups.Results. The extent of the reduction in eGFR was significantly greater in the added treatment group than in the control group (−3.83  versus −1.08 mL/min/1.73 m2,P=0.001). In multivariable analyses, the change in eGFR was positively associated with the change in UACR in the added treatment group (β=0.20,P=0.001), but not in the control group (β=−0.002,P=0.97). When the changes in eGFR were divided by each CKD stage, eGFR was significantly more decreased in stage 1 than in the other stages in the added treatment group (P<0.001), but no differences were seen in the control group (P=0.44).Conclusion. The reduction of eGFR could be seen only in the early stage of CKD, and this treatment appeared to have no negative effect on renal function.

Clinical efficacy of adjuvant therapy with hyperbaric oxygen in diabetic nephropathy

2020 ◽  
pp. 415-430
Author(s):  
Karime Guadalupe Cardenas Ureña ◽  
◽  
Julio César Ramírez Nava ◽  
Félix Guillermo Márquez Celedonio ◽  
Omar Israel Salas Nolasco ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Relative Risk ◽  
Glomerular Filtration ◽  
Risk Reduction ◽  
Hyperbaric Oxygen ◽  
Filtration Rate ◽  
Clinical Stage ◽  
Ambient Air ◽  
Urinary Albumin ◽  
Control Group

Background and objective: Diabetic kidney disease (DKD) is the most common microvascular chronic complication of diabetes mellitus. Hyperbaric oxygen (HBO2) therapy will increase the partial pressure of oxygen (PaO2) and may improve cell repair processes, which can lead to better renal function. The objective of this study was to quantify the efficacy of adjuvant HBO2 to increase the glomerular filtration rate and urinary albumin excretion in diabetic patients, as well as determine its effectiveness to modify the clinical course of DKD. Materials and methods: An experimental study was performed on patients with stage 3 and 4 DKD. Twenty sessions of HBO2 or ambient air in a hyperbaric chamber were administered. Estimated glomerular filtration rate, urine albumin:creatinine ratio calculation and clinical stage stratification were made prior to and after HBO2 administration. A descriptive, inferential and clinical efficacy analysis was performed. Results: Urinary albumin/creatinine (UACR) mean values prior to HBO2 were 1452.9 ± 644.3 mg/g and decreased to 876.1 ± 504.0 mg/g at the end of the study (p=0.06). The patients in the control group showed a UACR mean of 2784.5 ± 2128.6 mg/g and 2861.4 ± 2424.2 mg/g at baseline and at the end of the study, respectively (p=0.82). Patients in the experimental/HBO2 group showed an estimated GFR of 27.3 ± 9.5 mL/min /1.73m2 before HBO2, with a 34.4 ± 6.9 mL/min/1.73m2 after treatment (p=0.017); control group eGFR was 30.1 ± 9.2 mL/min/1.73m2, decreasing to 22.2 ± 6.8 mL/min/1.73m2 (p=0.004). Relative risk 0.00, relative risk reduction -100%, absolute risk reduction -71.4%, 95% CI (-104.9% to -38.0%), NNT 1, 95% CI (1 to 3). Conclusions: Management with HBO2 for DKD was associated with decreased excretion urinary albumin, improved GFR and clinical stage of patients in stages 3 and 4 of kidney damage unlike those receiving ambient air.

Effect of Proportional Reduction of Sodium Intake on the Adaptive Increase in Glomerular Filtration Rate/Nephron and Potassium and Phosphate Excretion in Chronic Renal Failure in the Rat

1975 ◽  
Vol 49 (3) ◽  
pp. 193-200 ◽  
Author(s):  
C. H. Espinel
Keyword(s):  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Renal Failure ◽  
Glomerular Filtration ◽  
Sodium Excretion ◽  
Filtration Rate ◽  
Sodium Intake ◽  
Dietary Sodium ◽  
Control Group ◽  
Phosphate Excretion

1. The influence of dietary sodium intake on the glomerular filtration rate (GFR/nephron) and potassium and phosphate excretion was examined at three stages of progressive chronic renal failure produced in rats by sequential partial nephrectomies. 2. The adaptive increased sodium excretion per nephron in the control group receiving a constant sodium intake did not occur in the experimental group that had a gradual reduction of dietary sodium in direct proportion to the fall in GFR. 3. Despite the difference in sodium excretion, the increase in GFR/nephron, the daily variation in the amount of potassium and phosphate excreted, the increase in potassium and phosphate excretion per unit nephron, and the plasma potassium and phosphate concentrations were the same in the two groups. 4. The concept of ‘autonomous adaptation’ in chronic renal failure is presented.

scholarly journals Performance of Cystatin C– and Creatinine-Based Estimated Glomerular Filtration Rate Equations Depends on Patient Characteristics

2015 ◽  
Vol 61 (10) ◽  
pp. 1265-1272 ◽  
Author(s):  
Jeffrey W Meeusen ◽  
Andrew D Rule ◽  
Nikolay Voskoboev ◽  
Nikola A Baumann ◽  
John C Lieske
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Patient Characteristics ◽  
Transplant Recipients ◽  
Ckd Stage ◽  
Measured Gfr

Abstract BACKGROUND The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends use of a cystatin C–based estimated glomerular filtration rate (eGFR) to confirm creatinine-based eGFR between 45 and 59 mL · min−1 · (1.73 m2)−1. Prior studies have demonstrated that comorbidities such as solid-organ transplant strongly influence the relationship between measured GFR, creatinine, and cystatin C. Our objective was to evaluate the performance of cystatin C–based eGFR equations compared with creatinine-based eGFR and measured GFR across different clinical presentations. METHODS We compared the performance of the CKD-EPI 2009 creatinine-based estimated GFR equation (eGFRCr) and the newer CKD-EPI 2012 cystatin C–based equations (eGFRCys and eGFRCr-Cys) with measured GFR (iothalamate renal clearance) across defined patient populations. Patients (n = 1652) were categorized as transplant recipients (n = 568 kidney; n = 319 other organ), known chronic kidney disease (CKD) patients (n = 618), or potential kidney donors (n = 147). RESULTS eGFRCr-Cys showed the most consistent performance across different clinical populations. Among potential kidney donors without CKD [stage 2 or higher; eGFR &gt;60 mL · min−1 · (1.73 m2)−1], eGFRCys and eGFRCr-Cys demonstrated significantly less bias than eGFRCr; however, all 3 equations substantially underestimated GFR when eGFR was &lt;60 mL · min−1 · (1.73 m2)−1. Among transplant recipients with CKD stage 3B or greater [eGFR &lt;45 mL · min−1 · (1.73 m2)−1], eGFRCys was significantly more biased than eGFRCr. No clear differences in eGFR bias between equations were observed among known CKD patients regardless of eGFR range or in any patient group with a GFR between 45 and 59 mL · min−1 · (1.73 m2)−1. CONCLUSIONS The performance of eGFR equations depends on patient characteristics that are readily apparent on presentation. Among the 3 CKD-EPI equations, eGFRCr-Cys performed most consistently across the studied patient populations.

Vascular Calcification in Patients with Early-Stage Chronic Kidney Disease: The Pivotal Role of Estimated Glomerular Filtration Rate

2021 ◽  
Vol 104 (6) ◽  
pp. 989-997
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Vascular Calcification ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Early Stage ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic

Background: Vascular calcification in advanced chronic kidney disease (CKD) is correlated with uremic toxins and severely impaired calciumphosphate- parathyroid metabolism. The association factors of vascular calcification in early-stage CKD are still unestablished. Objective: To identify the risk factors for vascular calcification in the early-stage CKD, which was the non-target population, different from other previous studies that explored this association in advanced stage CKD. Materials and Methods: The present study was a longitudinal study conducted to examine the risk factors of vascular calcification in CKD stage G2 and G3 patients who had no previous cardiovascular diseases. All parameters including coronary artery calcification (CAC) and abdominal aortic calcification (AAC) at baseline and after twelve months were evaluated. Results: Twenty-two patients without established cardiovascular diseases were included and completed the follow-up period. Mean baseline LDL was 99 mg/dL and no patient received statin. At 12-month, the median CAC score was significantly increased to 266 (126 to 956) versus 282 (198 to 846), (p=0.024]. By multivariable analysis in generalized estimating equations, only estimated glomerular filtration rate (eGFR) was associated with CAC score greater than 400 (aOR 0.92, p=0.041), and AAC score greater than 5 (aOR 0.90, p=0.023). Conclusion: In early-stage CKD, eGFR was associated with vascular calcification. Further studies should explore the potential benefits of delaying CKD progression on vascular calcification in the early-stage CKD patients. Keywords: Chronic kidney disease; Vascular calcification; Coronary artery calcification; Abdominal aortic calcification; Glomerular filtration rate; Renal function

scholarly journals Effect of Atorvastatin and Losartan on Glomerular Filtration Rate in Patients With Mild to Moderate Chronic Kidney Disease

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 43-47
Author(s):  
Md Moniruzzaman Khan ◽  
Zesmin Fauzia Dewan ◽  
AKM Shahidur Rahman ◽  
Bakhtiare Md Shoeb Nomany ◽  
Ahmed Salam Mir ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Kidney Diseases ◽  
Cell Damage ◽  
Renoprotective Effect ◽  
Ckd Stage

Background: Atorvastatin, a member of HMG CO-A reductase inhibitors, has been shown to have renoprotective effect in patients with Chronic Kidney Disease (CKD). Statins are supposed to decrease the oxidized lipid particles, suppress the activity of inflammatory mediators and prevent vascular thrombosis and thus could minimize renal cell damage. Losartan, an antihypertensive drug also diminishes proteinuria in patients with chronic kidney diseases or diabetes mellitus. Therefore the effect of concurrent use of atorvastatin and losartan on Glomerular Filtration Rate (GFR) could be a matter of interest from both Pharmacological and Clinical perspective. Objective: To assess the renoprotective effect of atorvastatin and losartan in patients with chronic kidney disease treated at Bangabandhu Sheikh Mujib Medical University (BSMMU). Materials and Method: Total forty four (44) patients suffering from CKD (stage one to stage three) were enrolled into two groups. Patients in Group A, received atorvastatin (10 mg) and losartan (50 mg) once daily for eight weeks. Patients in Group B, received losartan but not atorvastatin for the same duration. Serum creatinine level was measured at the commencement and also after eight weeks to calculate estimated glomerular filtration rate (eGFR) in individual patients with MDRD (Modification of Diet in Renal Disease) study equation. Results: There was significant (P < 0.001) reduction of Serum Creatinine and significant (P < 0.001) increase in e GFR in the patients, treated with atorvastatin and losartan. Conclusion: Concurrent administration of atorvastatin and losartan increased glomerular filtration rate (GFR) significantly in patients with chronic kidney disease. KYAMC Journal Vol. 10, No.-1, April 2019, Page 43-47

scholarly journals Chronic exposure to cadmium is associated with a marked reduction in glomerular filtration rate

2018 ◽  
Vol 12 (4) ◽  
pp. 468-475 ◽  
Author(s):  
Soisungwan Satarug ◽  
Kanyarat Boonprasert ◽  
Glenda C Gobe ◽  
Ronnatrai Ruenweerayut ◽  
David W Johnson ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Chronic Exposure ◽  
Filtration Rate ◽  
Positive Association ◽  
Population Based ◽  
Urinary Albumin ◽  
Cross Sectional ◽  
Men And Women ◽  
Albumin Excretion

Abstract Background Urinary 20-hydroxyeicosatetraenoic acid (20-HETE) has been associated with hypertension in women with elevated urinary cadmium (Cd) excretion rates. The present study investigates the urinary Cd and 20-HETE levels in relation to the estimated glomerular filtration rate (eGFR) and albumin excretion in men and women. Methods A population-based, cross-sectional study, which included 225 women and 84 men aged 33–55 years, was conducted in a rural area known to be polluted with Cd. Results In all subjects, lower eGFR values were associated with higher urinary Cd excretion (P = 0.030), and tubulopathy markers N-acetyl-β-d-glucosaminidase (P < 0.001) and β2-microglobulin (β2-MG) (P < 0.001). On average, the hypertensive subjects with the highest quartile of urinary Cd had eGFR values of 12 and 17 mL/min/1.73 m2 lower than that in the hypertensive (P = 0.009) and normotensive subjects (P < 0.001) with the lowest quartile of urinary Cd, respectively. In men, urinary albumin was inversely associated with 20-HETE (β = −0.384, P < 0.001), while showing a moderately positive association with systolic blood pressure (SBP) (β = 0.302, P = 0.037). In women, urinary albumin was not associated with 20-HETE (P = 0.776), but was associated with tubulopathy, reflected by elevated urinary excretion of β2-MG (β = 0.231, P = 0.002). Conclusions Tubulopathy is a determinant of albumin excretion in women, while 20-HETE and SBP are determinants of urinary albumin excretion in men. Associations of chronic exposure to Cd with marked eGFR decline and renal tubular injury seen in both Cd-exposed men and women add to mounting research data that links Cd to the risk of developing chronic kidney disease.

scholarly journals Effect of prenatal programming and postnatal rearing on glomerular filtration rate in adult rats

2015 ◽  
Vol 308 (5) ◽  
pp. F411-F419 ◽  
Author(s):  
German Lozano ◽  
Ayah Elmaghrabi ◽  
Jordan Salley ◽  
Khurrum Siddique ◽  
Jyothsna Gattineni ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Control Group ◽  
Adult Rats ◽  
Pregnant Rats ◽  
Mature Adult ◽  
Low Protein

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.

Early Glomerular Filtration Rate Loss as a Marker of Diabetic Nephropathy

2012 ◽  
Vol 08 (01) ◽  
pp. 40 ◽  
Author(s):  
George Jerums ◽  
Elif Ekinci ◽  
Sianna Panagiotopoulos ◽  
Richard J MacIsaac ◽  
◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Clinical Level ◽  
Ckd Stage

In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2(chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.

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