scholarly journals Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group.

Hypertension ◽  
1989 ◽  
Vol 13 (5_Suppl) ◽  
pp. I80-I80 ◽  
Author(s):  
N. B. Shulman ◽  
C. E. Ford ◽  
W. D. Hall ◽  
M. D. Blaufox ◽  
D. Simon ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Prognostic Value ◽  
Cooperative Group ◽  
Hypertension Detection ◽  
Treatment Of Hypertension ◽  
Effect Of Treatment

scholarly journals P0657CHANGES IN CREATININE MAY NO REFLECT MEASURED RENAL FUNCTION CHANGES IN PREDIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Escamilla Cabrera Beatriz ◽  
Nuria Victoria Sánchez Dorta ◽  
Natalia Negrã­n Mena ◽  
Sergio Luis-Lima ◽  
Federico Gonzalez Rinne ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Practice ◽  
Nutritional Status ◽  
Serum Creatinine ◽  
Outpatient Clinic ◽  
Intestinal Secretion ◽  
Repeated Measurement ◽  
Clinical Evolution ◽  
Measured Gfr

Abstract Background and Aims Serum creatinine is the most used biomarker of renal function in clinical practice. However, the correlation between creatinine and measured GFR is poor with a variability as wide as 200%. The causes of this phenomena are not clear. Some studies observed tubular handling (reabsorption and secretion) as well as intestinal secretion of creatinine, and depends of nutritional status . Importantly, these changes increased with the loss of renal function, masking changes in the evolution of real renal function. However, scarce evidence is available about the reliability of creatinine in reflecting the changes of renal function over the time in predialysis patients, compared to measured GFR. This information is relevant in the setting of clinical decisions. Method Spanish unicenter study developed at the Hospital Universitario de Canarias (Tenerife). In the pre-dialysis outpatient clinic, subjects are followed with measured GFR (clearance of iohexol by DBS). Measured GFR is performed at baseline and repeated as suggested by the clinical evolution. For this study we included all patients with repeated determinations of creatinine and measured GFR. The changes of creatinine in terms of increase (>10%), decrease (<10%) and stability (±10%) were compared with the changes in measured GFR. Results 89 cases with repeated measurement of GFR and creatinine were evaluated. In 61 cases (68.53%) discrepancies between changes in creatinine and measured GFR were evident. Graphic 1 shows differents discordancing cases with 39 cases (43.8%) overestimation, 7 (7.8%) of infraestimation and 15 cases (24.7%) not change of mGFR with changes on Cr. Conclusion Changes in creatinine do not reflect real changes in real renal function in about 70% of the cases. Whenever possible, the measurement of GFR by whichever method available should be considered in the renal care and follow-up of these patients.

scholarly journals A patient with severe rhabdomyolysis and high levels of creatinine kinase had renal functions fully recovered after haemodialysis: a case report

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988810 ◽  
Author(s):  
Shang-Feng Tsai ◽  
Jun-Li Tsai ◽  
Cheng-Hsu Chen
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Predictive Power ◽  
Kidney Injury ◽  
Blood Biomarkers ◽  
History Of ◽  
Very High ◽  
Current Report

Rhabdomyolysis is diagnosed based on the levels of blood biomarkers such as creatine kinase (CK), but the use of CK levels to predict long-term renal function remains controversial. This current report presents a case with a very high CK level with the presentation of acute kidney injury (AKI) who regained full renal function. A 29-year-old man, in a manic mood and presenting with dyspnoea, was admitted to hospital following an episode of ketamine use along with a history of drug abuse. The laboratory analyses identified rhabdomyolysis (CK, 35 266 U/l) and AKI (serum creatinine, 3.96 mg/dl). Despite treatment with intravenous normal saline (4000 ml/day), his CK level reached at least 300 000 U/l. He underwent 13 sessions of haemodialysis and his renal function fully recovered. The final measurements were serum creatinine 1.0 mg/dl and CK 212 U/l. These findings support the view that the predictive power of CK level on AKI is limited, especially regarding long-term renal function. Close follow-up examinations of renal function after haemodialysis are mandatory for patients with rhabdomyolysis.

Identification Of aHUS and Complement Mutations In Patients Presenting With Acute Thrombotic Microangiopathy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1073-1073
Author(s):  
Elizabeth H Phillips ◽  
John Connolly ◽  
John-Paul Westwood ◽  
Siobhan McGuckin ◽  
Daniel P Gale ◽  
...  
Keyword(s):  
Renal Function ◽  
Platelet Count ◽  
Serum Creatinine ◽  
Normal Serum ◽  
Control Group ◽  
Complement Inhibitor ◽  
Complement Pathway ◽  
Alternative Complement ◽  
Normal Serum Creatinine

Abstract Increasing understanding of abnormalities within the alternative complement pathway in atypical hemolytic uremic syndrome (aHUS) is changing the way the disease is both diagnosed and treated. It is rarely possible to definitively diagnose aHUS at the time of initial acute presentation and treatment, with plasma exchange, is initiated on clinical grounds. With the risk of further acute episodes and increasing availability of terminal complement inhibitors accurate molecular diagnosis is imperative. Aim to determine the clinical phenotype and nature of complement abnormalities within a cohort of aHUS patients referred to a large thrombotic thrombocytopenic purpura (TTP) referral centre. Patients and methods Data from 14 patients with a clinical diagnosis of aHUS was retrospectively analysed. 13 patients were referred with thrombotic microangiopathy not initially requiring renal replacement therapy (RRT). 1 patient presented to another institution requiring urgent RRT and was subsequently transferred to our care following recovery of renal function. All patients had ADAMTS13 levels above 30% and negative anti-ADAMTS13 antibody levels at presentation to exclude a diagnosis of TTP. 3 patients had diarrhoea at presentation; all were enterotoxin negative. Patients were subsequently assessed for mutations within complement factors H (CFH), I (CFI), B (CFB), C3 and membrane cofactor protein (MCP), at risk haplotypes and CFH antibodies. A control group of 14 acute acquired TTP patients with confirmed ADAMTS13 levels <5% were assessed for the same abnormalities within complement regulatory proteins. Results In the aHUS cohort, the median age of presentation was 25.5 years (11 months to 72 years). The median serum creatinine was 275 µmol/l (range 79-1812 µmol/l), platelet count 27 x109/l (10-115) and LDH was 2016 IU (342-4621). In the TTP group, presenting creatinine was 106 µmol/l (61-353) µmol/l, platelets 13 x109/l (5-74) and LDH 1954 IU (756-3518). aHUS precipitants at initial presentation or relapse included pregnancy (n=2), upper respiratory tract infection (n=6), vaccination (n=1), abdominal sepsis (n=4). In 3 cases, there was no identified trigger. Headache was a common presenting symptom; only one hypertensive patient (72 years) had a transient ischemic attack; no other neurological events were documented in the aHUS group. In 57% (8/14 patients) variants of the alternative complement pathway were identified; 5 with MCP mutations, encoding p.R59X, p.C157Y (present in 2 brothers), p.C64F and c.286+2T>C/c.286+2T>G (both present in the same patient); 2 with CFH mutations, encoding c.3134-5T>C and p.R1215X; and 1 with a CFB mutation (p.D371G). All of the mutations identified, except CFH c.3134-5T>C, are of clear functional significance. 2 of the patients with MCP mutations had a normal serum creatinine at presentation. C3/4 levels were low in 3/8 patients. In the control group of TTP patients with ADAMTS13 <5% no complement mutations were identified. 13/14 aHUS patients were treated initially with plasma exchange; 1 received eculizumab subsequently. 3 patients required temporary RRT and 1 died within 24 hours of presentation with progressive cardiorespiratory failure. At follow-up, all patients had platelet counts >150 x109/l and 12/13 had normal serum creatinine levels; one patient had a creatinine of 122 µmol/l. 5/13 patients had recurrent episodes, 4 of whom had confirmed complement pathway abnormalities (3 MCP mutated, 1 CFB mutated). None required long-term RRT or progressed to end-stage renal failure (ESRD) at a median follow-up of 2 years (range 0.25-28 years). Conclusions This aHUS cohort, without ESRD, demonstrates the difficulty in clinically differentiating TTP from complement mediated TMAs. We demonstrate that diagnostic differentiation based on platelet count, renal function and serum C3/C4 levels is insufficient to predict an underlying complement mutation. This distinction is increasingly important with the proven efficacy of complement inhibitor therapy in targeting complement activation in aHUS. Specifically, we demonstrate a very high frequency of functionally significant MCP mutations which mimic relapsing/remitting TTP. An ADAMTS13 activity >5% in a patient with a TMA should necessitate genetic screening for complement gene mutations prior to consideration of complement inhibitor therapy. Disclosures: No relevant conflicts of interest to declare.

Renal Disease In Patients With Chronic Lymphocytic Leukemia (CLL)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5302-5302 ◽  
Author(s):  
Tait D Shanafelt ◽  
Kari G. Rabe ◽  
Curtis A Hanson ◽  
Timothy G. Call ◽  
Susan Schwager ◽  
...  
Keyword(s):  
Renal Function ◽  
Chronic Lymphocytic Leukemia ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Research Funding ◽  
Univariate Analysis ◽  
Lymphocytic Leukemia ◽  
Disease Course ◽  
To Receive

Abstract Background Chronic lymphocytic leukemia (CLL) can effect renal function in a variety of ways including direct infiltration of the kidney, ureteral obstruction by lymphadenopathy, and treatment related tumor lysis syndrome (uric acid nephropathy). Rarely, CLL has also been reported to be associated with light chain nephropathy, renal amyloidosis, membranoproliferative glomerulonephritis (MPGN), granulomatous interstitial nephritis (GIN), and minimal change disease (MCD). Nearly all the data on the effects of CLL on renal function is at the case report level. We systematically evaluated the prevalence of renal insufficiency at diagnosis as well the incidence of acquired renal insufficiency during follow-up in a large cohort of patients with newly diagnosed CLL to more accurately define the effects of CLL on the kidney and its impact on clinical outcomes. Methods Between January 1995 -February 2013, previously untreated CLL patients seen in the Division of Hematology at Mayo Clinic at diagnosis (<12 months) and who had baseline assessment of serum creatinine were included in this analysis. Patients with serum creatinine (Cr) ≥1.5 mg/dL at baseline were classified as having renal insufficiency at diagnosis. Patients who initially had baseline creatinine <1.5 mg/dL but who developed a Cr≥1.5 mg/dL during the course of their disease were considered to have acquired renal insufficiency. Results Existing renal insufficiency at the time of CLL diagnosis: Of 2047 patients who met the eligibility criteria, 153 (7.5%) patients had renal insufficiency (Cr≥1.5 mg/dL) at the time of CLL diagnosis including 15 (0.7%) with a Cr≥3 mg/dL. Renal insufficiency was also more common among men (9.3% vs. 3.9%; p<0.00001), those with advanced stage disease (Rai 0=7.0%; Rai I-II=6.4%, Rai III-IV=20.2%; p<0.0001), and CD49d positive patients (6.8% vs. 3.8%; p<0.038). Patients with renal insufficiency at diagnosis were also older (median age 72.2 vs. 63.9; p<0.0001). No difference in the prevalence of renal insufficiency at diagnosis was observed based on cytogenetic abnormalities detected by FISH or CD38, ZAP-70 or IGHV gene mutation status. Although renal insufficiency at diagnosis was strongly associated with OS on univariate analysis (p<0.001), no association was observed between renal insufficiency and TTT or OS on multi-variate analysis adjusting for age, sex, and Rai stage. Acquired renal insufficiency during CLL disease course: Among the 1894 patients with normal renal function at diagnosis, 304 (16.1%) acquired renal insufficiency (Cr≥1.5 mg/dL) during the course of their CLL disease course including 43 (2.3%) with peak Cr≥3 mg/dL. In addition to age (older) and male sex, a number of CLL disease characteristics were associated with a higher likelihood of acquired renal insufficiency including: IGHV UM (OR=2.0; p=0.0001), unfavorable FISH (del17p- or 11q-; OR=2.0; p=0.001), and being CD49d+ (OR=1.8; p=0.002), ZAP-70+ (OR=1.6; p=0.004), or CD38+ (OR=1.4; p=0.0.032),. Shorter TTT (p<0.001) and OS (P<0.001) was observed among patients with initially normal creatinine who acquired renal insufficiency (Figure 1A and 1B). On MV analysis adjusting for age, sex, and stage at diagnosis, acquired renal insufficiency remained an independent predictor of TTT (OR=1.77; p=0.001) and OS (OR=2.67; p<0.001). Renal insufficiency and therapy selection After median follow-up of 4.5 years (range 0-18.0), 620 of 2047 (30.3%) patients have progressed to require treatment. Patients with renal insufficiency prior to treatment were less likely to receive purine nucleoside analogue based therapy and more likely to receive single agent alkylator based treatment. Conclusions Approximately 1 in every 13 patients (7.5%) with CLL has renal insufficiency at the time of diagnosis and an additional 16.1% acquire renal insufficiency during the course of the disease. The risk of developing renal insufficiency is associated with a variety of CLL B-cell characteristics and is associated with TTT and OS. Data on causes of acquired renal insufficiency is being abstracted and will be presented at the meeting. Disclosures: Shanafelt: Genentech: Research Funding; Glaxo-Smith-Kline: Research Funding; Cephalon: Research Funding; Hospira: Research Funding; Celgene: Research Funding; Polyphenon E International: Research Funding. Off Label Use: MK2206 in a phase 1 trial of CLL.

scholarly journals Urolithiasis Associated with Renal Impairment: Management and its Outcome

2019 ◽  
Vol 20 (1) ◽  
pp. 18-23
Author(s):  
Md Jamal E Rabby ◽  
Md Masud Zaman ◽  
Mohammad Ali ◽  
Md Kabirul Hassan ◽  
Md Shohidul Lslam ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Functional Outcome ◽  
Urinary Stone ◽  
Duration Of Symptoms ◽  
Baseline Serum ◽  
Stone Clearance ◽  
Stone Burden

Background: Urolithiasis may be associated with various degree of renal impairment secondaryto a combination of obstruction, urinary infection, long standing calculus, stone burden,frequent surgical intervention, and co-existing medical diseases. Objective: The purpose of the study is to predict the factors those have a significant impact foroutcome of the patients with renal impairment following treatment of urolithiasis. Methods: Fifty patients of urolithiasis with renal impairment were enrolled in this prospectivestudy, carried out between 1st July, 2008 and 30th June, 2009, at department of Surgery,Shaheed Ziaur Rahman Medical College Hospital, Bogra. Patients with renal impairment wasdefined as a baseline serum creatinine of >1.2mg/dl and/or on the basis of DTPA isotoperenogram findings (mild, moderate or severe impairment). Definite management was carriedout by means of open surgery, ESWL or in combinations available at study place. Follow-up after3 months, the postoperative renal functional outcome was defined as improved (>20% fall inserum creatinine), stabilized (<20% rise or <20% fall in serum creatinine), or deteriorated(>20% rise in serum creatinine). Renal function was also assessed by the impression madefrom the graph of DTPA isotope renogram (normal functioning or mild, moderate and severeimpairment). Predictive factors to be evaluated for the stone clearance and renal functionaloutcome were age of the patients, duration of symptomatology and urolithiasis, associateddiseases (hypertension and diabetes mellitus), stone burden, stone number and associatedurinary infection. Results: After 3 months of follow-up, the overall stone clearance rate was 76%. Out of 50patients, 27 patients (54%) showed improvement, 19 patients (38%) showed stabilization, and04 patients (08%) showed deterioration in their renal function. Age <40 years, duration ofsymptoms <6 months, stone burden <5 cm2 and single urinary stone were significant predictorsof subsequent good renal functional outcome. Conclusion: The renal recoverability rate after treatment of urinary stone disease could bepredicted by age, duration of symptoms, stone burden and stone number Journal of Surgical Sciences (2016) Vol. 20 (1) : 18-23

scholarly journals Incidence and Progress of Vesicoureteric Reflux after Primary Fulguration of Posteriorurethralvalves

2015 ◽  
Vol 3 (2) ◽  
pp. 71-77
Author(s):  
MM Masud Pervez ◽  
Kaniz Hasina ◽  
Md Ashraf Ul Huq
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Creatinine Level ◽  
Pearson Correlation ◽  
Vesicoureteric Reflux ◽  
Correlation Test ◽  
Positive Correlation ◽  
Before And After ◽  
Pearson Correlation Test

Introduction: Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions usually result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function.Materials and methods: We conducted interventional study among 30 purposively selected patients of PUV in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 20 months from December 2009 to July 2011. Age of study subjects varied from 2 days to 14 years. Among the 30 patients, 16 were children in the age group between 1year to14 years (53.3%), 11(36.7%) were infants and the rest 03(10%) were neonates. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI and palpable bladder. All children were subjected to ultrasonography (USG), blood urea, serum creatinine, routine urine examination and culture studies. Structured questionnaire was used to collect information regarding improvement or disappearance of VUR and renal functional status before & after primary fulguration of PUV.Results: Average serum creatinine level was found gradually decreased in subsequent follow up in comparison with the previous one. This difference of creatinine level was found statistically significant in t-test (p<0.01). Average blood urea nitrogen (BUN) was also decreased which was found statistically significant (p<0.05). VUR was present in 63.3% cases. Non- VUR was found in 60% cases on right side and 50% cases on left side. On the third follow-up after 3 months it became 73.3% on right side and 63.3% on left side. Positive correlation found in Pearson correlation test about the changes of reflux grades before and after fulguration was significant at the level of 0.01(p<0.001). It was significant on both left and right kidneys. Positive correlation found in Pearson correlation test about the changes of GFR before and after fulguration was also significant at the level of 0.01(p <0.001). Collected data was cleaned, edited and analyzed with the help of software SPSS window version 15.0.Conclusion: In this study, VUR disappeared in some cases and decreased in majority of the cases by 3 months after adequate restoration of urethral patency. Renal function came to normal range in two thirds of the cases.J. Paediatr. Surg. Bangladesh 3(2): 71-77, 2012 (July)

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