Pathogenesis and Assessment of Renal Function in Patients With Liver Cirrhosis

Folia Medica ◽  
2012 ◽  
Vol 54 (4) ◽  
pp. 5-13 ◽  
Author(s):  
Bilyana H. Teneva
Keyword(s):  
Renal Function ◽  
Liver Cirrhosis ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Serum Markers ◽  
Meld Score ◽  
Kidney Damage ◽  
Early Assessment

Abstract In liver cirrhosis patients awaiting liver transplantation, it is prognostically equally important to assess the renal function before and after transplantation. This is evidenced by the inclusion of serum creatinine in the Model for End-Stage Liver Disease (MELD) score. Most of the causes of renal failure in liver cirrhosis are functional, the acute kidney damage including prerenal azotemia, acute tubular necrosis and hepatorenal syndrome. A major index of the renal function, the glomerular filtration rate (GFR) is determined in a specific way in patients with liver cirrhosis. Clinically, serum creatinine is considered the best indicator of kidney function, although it is rather unreliable when it comes to early assessment of renal dysfunction. Most of the patients with liver cirrhosis have several concomitant conditions, which are the reason for the false low creatinine levels, even in the presence of moderate to severe kidney damage. This also holds for the creatinine clearance and creatinine-based estimation equations for assessment of the glomerular filtration rate (the Cockroft-Gault and MDRD formulas), which overestimate the real glomerular filtration. Clearance of exogenous markers is considered a gold standard, but the methods for their determination are rather costly and hard to apply. Alternative serum markers (e.g., cystatin C) have been used, but they should be better studied in cases of liver cirrhosis assessment.

scholarly journals Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

2012 ◽  
Vol 130 (5) ◽  
pp. 289-293 ◽  
Author(s):  
Alexandre Libório ◽  
Russian Uchoa ◽  
João Neto ◽  
Juan Valdivia ◽  
Elizabeth De Francesco Daher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Severe Heart Failure ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Gfr Estimation

CONTEXT AND OBJECTIVE: Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. DESIGN AND SETTING: Cross-sectional observational study at a university reference center. METHODS: GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis. RESULTS: This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). CONCLUSION: Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.

scholarly journals P0223AGING CHANGES OF RENAL FUNCTION AND EVALUATION OF DIFFERENT GLOMERULAR FILTRATION RATE ESTIMATION EQUATIONS IN HEALTH PEOPLE IN BEIJING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lengnan Xu ◽  
Yonghui Mao ◽  
Aiqun Chen ◽  
Ban Zhao
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Age Groups ◽  
The Elderly ◽  
The Body ◽  
True Value ◽  
Age Related

Abstract Background and Aims The kidney is an important organ that removes metabolites and certain wastes and poisons from the body, and retains water and other useful substances through reabsorption. Its aging and function decline have a significant impact on the human health.Rather than simply depending on serum creatinine, glomerular filtration rate (GFR) assessment equation should be given priority in evaluating renal function. Different evaluated GFR (eGFR) equations sometimes have great differences in assessing the true value of GFR, especially for the elderly. The purpose of this study was to analyze the aging changes of renal function in normal people in Beijing and to compare the significance of different eGFR equations in evaluating renal function in Chinese population. Method The age, sex and serum creatinine were recorded in the population who underwent routine physical examination in our hospital from January 2012 to December 2014. Kidney function was assessed by CKD-EPI, MDRD, MDRDc, FAS and BIS equations, respectively. Results A total of 46 713 persons were enrolled in this study, of whom 27 249 (58.33%) were males. They were followed up for 3 years, ranging in age from 16 to 100 years. Both men and women showed age-related change in serum creatinine: serum creatinine and its standard deviation gradually increases parallel with age, indicating that the range of serum creatinine changes in the elderly was larger. Whether male or female, there were differences in eGFR change between different age groups (male: Χ2=141.28, P=0.000; female: Χ2=97.55, P=0.000). For male, eGFR decreased more in the elderly, and it was more common for young people to keep the eGFR constant or increase. However, in female, eGFR remained unchanged in most old people, and increased or decreased in the majority of the young. For all age groups, the ICC was very consistent among the equations, 0.849 for males and 0.817 for females. The whole population was divided into three groups according to serum creatinine &lt; 1mg/dL, &gt; 1mg/dL and &lt; 1.5mg/dL, &gt; 1.5mg/dL. The CKD-EPI equation gave higher stages of CKD than other equations. There was no clear age-related change trend in the 3-year average eGFR change rate of all age groups. For the elderly over 70 years of age, the MDRD and MDRDc equations had higher GFR evaluation results than the other three equations. The BIS equation had the lowest results of all equations. The ICC was very consistent among the equations, 0.966 for males and 0.957 for females. Conclusion we believed that the annual change of GFR varied from person to person and had little to do with age. GFR needed to be calculated more accurately in order to formulate corresponding medical strategies. Those eGFR equations the above-mentioned can be used to evaluate renal function, but the results were very different for different populations and serum creatinine levels. The use of different eGFR equations may lead to large differences in drug dose adjustment and the risk of serious adverse reactions. For the elderly in China, which equation was more suitable was inconclusive and further research was urgently needed.

EXPRESS: Drug dosing using estimated Glomerular Filtration Rate: Misclassification due to metamizole interference in a creatinine assay

2021 ◽  
pp. 000456322110200
Author(s):  
Luana Bojko ◽  
Gustavo de Paula Ripka ◽  
Laura Mattana Dionísio ◽  
Celso Luiz Borges ◽  
Danielle Cristyane Kalva Borato ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Drug Dosing ◽  
Significant Difference ◽  
The Impact ◽  
Creatinine Measurement

The estimated glomerular filtration rate is a rather important measurement for patients under intensive care, since they often receive several drugs, and impaired renal function may result in misleading dosing. The estimated glomerular filtration is derived from mathematical models using serum creatinine, a measurement that suffers interference of some drugs, such as metamizole. The study intented to evaluate the impact on patient stratification for dose adjustment of two antimicrobials (meropenem and vancomycin) caused by metamizole interference in creatinine measurement by dry chemistry. A cross-sectional study was conducted with a group of 108 hospitalized patients under metamizole prescriptions at fixed intervals. Serum creatinine levels were determined by enzymatic dry chemistry and Jaffé assays and the estimated glomerular filtration rate was calculated through the CKD-EPI equation. Patients were stratified in groups according to their estimated glomerular filtration rate for drug dosing of vancomycin and meropenem. As expected, creatinine values were significantly lower in measurements performed by the dry chemistry method in comparison to Jaffé assay (p<0.0001) when patients are under metamizole treatment. A significant bias (-40.3%) was observed between those two methods, leading to a significant difference (p<0.0001) in patient classification according to renal function using the CKD-EPI equation for dosing adjustment. Thus, during the validity of metamizole treatment, the stratification for drug dosing by the estimated glomerular filtration rate is not reliable if the creatinine measurement is done through dry chemistry. Clinical and laboratory staff must be aware of these limitations and cooperate to optimize pharmacotherapy.

Renal function – estimation of glomerular filtration rate

2006 ◽  
Vol 44 (11) ◽  
Author(s):  
Lothar Thomas ◽  
Andreas R. Huber
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Routine Laboratory ◽  
Prediction Equations

AbstractAssessment and follow-up of renal dysfunction is important in the early detection and management of chronic kidney disease. The glomerular filtration rate (GFR) is the most accurate measurement of kidney disease and is reduced before the onset of clinical symptoms. Drawbacks to the measurement of GFR include the high cost and incompatibility with routine laboratory monitoring. Serum creatinine determination is a mainstay in the routine laboratory profile of renal function. The measurement of serum cystatin C has been proposed as a more sensitive marker for GFR. According to National Kidney Foundation-K/DOQ1 clinical guidelines for chronic kidney disease, serum markers should not be used alone to assess GFR. Based on prediction equations, clinical laboratories should report an estimate of GFR, in addition to reporting the serum value. In this article, information is presented on how best to estimate GFR using prediction equations for adults and for children. Using serum creatinine concentration with the Modification of Diet in Renal Disease (MDRD) study equation offers a suitable estimation of GFR in adults. The cystatin C prediction equation with the use of a prepubertal factor seems superior to creatinine-based prediction equations in children of <14years.Clin Chem Lab Med 2006;44:1295–302.

Estimated glomerular filtration rate from serum creatinine in Brazil/changing in CKD

2017 ◽  
Vol 5 (4) ◽  
pp. 315-322
Author(s):  
Mark Fernandez Bedoya ◽  
Maria A. Hegeman
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Developed Countries ◽  
Cross Sectional ◽  
Progression Of Kidney Disease

Continued progression of kidney disease 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. Estimates of glomerular filtration rate (GFR) that are based on serum creatinine are routinely used; however, they are imprecise, potentially leading to the overdiagnosis of chronic kidney disease. The purpose of this study is to evaluate the glomerular filtration rate from serum creatinine in Brazil patients with chronic kidney disease (CKD). Multiple equations exist to estimate glomerular filtration rate (GFR); however, there is no consensus on which is superior for risk classification in patients with chronic kidney disease (CKD). Renal function was analyzed through serum creatinine and glomerular filtration rate (GFR) estimated according to the CG, MDRD and CKD-EPI equations, available on the websites of the Brazilian Nephrology Society (SBN) and the (NKF) by using cross-sectional analyses in diverse populations totaling 3949 participants.

scholarly journals Estimated glomerular filtration rate in patients with type 2 diabetes mellitus

2014 ◽  
Vol 60 (6) ◽  
pp. 531-537 ◽  
Author(s):  
Paula Caitano Fontela ◽  
Eliane Roseli Winkelmann ◽  
Joice Nedel Ott ◽  
Douglas Prestes Uggeri
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Diabetic Patients ◽  
Biochemical Tests ◽  
Strong Negative Correlation ◽  
Reduced Renal Function

Objective: to estimate the glomerular filtration using the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, and serum creatinine in the screening of reduced renal function in patients with type two diabetes (T2DM) enrolled in the Family Health Strategy (ESF, Brazilian federal health-care program). Methods: a cross-sectional descriptive and analytical study was conducted. The protocol consisted of sociodemographics, physical examination and biochemical tests. Renal function was analyzed through serum creatinine and glomerular filtration rate (GFR) estimated according to the CG, MDRD and CKD-EPI equations, available on the websites of the Brazilian Nephrology Society (SBN) and the (NKF). Results: 146 patients aged 60.9±8.9 years were evaluated; 64.4% were women. The prevalence of serum creatinine >1.2 mg/dL was 18.5% and GFR <60 mL/min/1.73m2 totaled 25.3, 36.3 and 34.2% when evaluated by the equations CG, MDRD and CKD-EPI, respectively. Diabetic patients with reduced renal function were older, had long-term T2DM diagnosis, higher systolic blood pressure and higher levels of fasting glucose, compared to diabetics with normal renal function. Creatinine showed strong negative correlation with the glomerular filtration rate estimated using CG, MDRD and CKD-EPI (-0.64, -0.87, -0.89) equations, respectively. Conclusion: the prevalence of individuals with reduced renal function based on serum creatinine was lower, reinforcing the need to follow the recommendations of the SBN and the National Kidney Disease Education Program (NKDEP) in estimating the value of the glomerular filtration rate as a complement to the results of serum creatinine to better assess the renal function of patients.

scholarly journals Evaluation of patient renal function following endovascular aneurysm repair with suprarenal fixation

2011 ◽  
Vol 1 (1) ◽  
pp. 10 ◽  
Author(s):  
YingBin Jia ◽  
Yun Shi ◽  
XiaoDong Guan ◽  
Jian Li ◽  
BaiMeng Zhang ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair

This study aimed to assess the mid-term renal function of abdominal aortic aneurysm patients following suprarenal endovascular repair. From March 2005 to December 2009, 290 abdominal aortic aneurysm patients were included in the study and grouped according to whether they had received infrarenal or suprarenal endovascular aneurysm repair. Suprarenal endovascular aneurysm repair was performed in 173 patients, with a mean age of 72(±8) years (85.0% male). Infrarenal endovascular aneurysm repair was performed in 117 patients, with a mean age of 71(±9) years (90.6% male). Preoperative and one week, 1-, 3-, 6- and 12-month postoperative serum creatinine and cystatin C values were recorded. Estimated glomerular filtration rate was calculated by cystatin-based formula and Cr-based Cockcroft formula. The t-test was used to determine statistical differences between or within groups. All patients received Talent or Zenith endograft. Patients’ characteristics and operative files in the two groups were well matched. Preoperative serum creatinine and cystatin C were 82 (±8) mmol/L and 0.89 (±0.11) mg/L for suprarenal endovascular aneurysm repair, respectively, and 81 (±11) mmol/L and 0.87 (±0.15) mg/L, respectively, for infrarenal endovascular aneurysm repair; no differences were observed between the two groups. Compared to preoperative renal markers within each group, a deterioration in serum creatinine, cystatin C and estimated glomerular filtration rate values was found at one week and 12 months after surgery（P&lt;0.05). A deterioration in cystatin C [SR:(0.93±0.17) mg/L, IR: (0.92±0.31) mg/L] and estimated glomerular filtration rate by cystatin C was also found at six months after surgery（P&lt;0.05). However, no differences in patient serum creatinine, cystatin C and estimated glomerular filtration rate values were observed between groups at each follow-up time interval. There was no greater significant difference in the association of the use of suprarenal fixation with midterm postoperative renal injury than with infrarenal fixation.

Assessment of renal function by serum creatinine and creatinine clearance: glomerular filtration rate estimated by four procedures.

1989 ◽  
Vol 35 (12) ◽  
pp. 2326-2330 ◽  
Author(s):  
F Van Lente ◽  
P Suit
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Wide Range ◽  
Clear Method ◽  
Serum And Urine

Abstract We compared creatinine concentrations in serum and urine and creatinine clearances determined by two Jaffé (Beckman's "Astra," Boehringer Mannheim Diagnostics) and two enzymatic (Kodak, Boehringer Mannheim Diagnostics) methods. Serum creatinine and creatinine clearances determined by each method were also compared with the glomerular filtration rate as measured with use of sodium [125I]iothalamate in patients with a wide range of renal function. Results between methods correlated excellently, but we saw clear method-dependent biases of up to 2.9 mg/L for serum. The highest serum creatinine values and the lowest creatinine clearances were obtained with Boehringer Mannheim Diagnostics' Jaffé method. The reciprocal of the serum creatinine and the creatinine clearance also correlated well with the glomerular filtration rate, but all methods over-estimated the glomerular filtration rates to varying degrees. Appropriate standardization of methods appears to be as important as method principle for establishing an accurate relationship between creatinine determinations and glomerular filtration rate.

Sign in / Sign up

Export Citation Format

Share Document