Trajectories of Glomerular Filtration Rate and Progression to End Stage Renal Disease After Kidney Transplantation

Abstract Context.—African Americans have a 4-fold greater risk than whites for developing end-stage renal disease. Glomerulomegaly, possibly related to obesity, has been identified in high-risk populations and is suggested to be a marker for end-stage renal disease risk. Objective.—To investigate differences in glomerular size and patient clinical characteristics at the time of renal biopsy for the major diseases contributing to end-stage renal disease. Design.—Mean glomerular tuft volumes were estimated by the Weibel-Gomez method (1964) in native renal biopsies of 203 African American and 100 white patients 18 years of age and older by point counting on a stereologic grid. Glomerulosclerosis was graded on individual glomeruli from 0 to 4, and a glomerular sclerosis index was calculated for each biopsy. Relationships between the mean volume of nonsclerotic glomeruli, age, sex, race, sclerosis index, cortical fibrosis, estimated glomerular filtration rate, body mass index, and disease diagnosis were analyzed. Results.—Racial differences in mean volume of nonsclerotic glomeruli and body mass index were not significant in any disease category, and African Americans had more severe disease as determined by sclerosis index, cortical fibrosis, and estimated glomerular filtration rate only in focal segmental glomerulosclerosis. For all patients, increased sclerosis index and cortical fibrosis and lower estimated glomerular filtration rate were best predicted by increased age (P < .001). Conclusions.—For approximately the same severity of disease, African Americans were 10 years or more younger than whites with the difference being seen in all disease categories except membranous glomerulonephritis and diabetes. Glomerulomegaly relative to whites was not a distinguishing feature of African American renal biopsies.

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Estimated glomerular filtration rate variability and risk of end-stage renal disease among patients with Stage 3 chronic kidney disease

Clinical Nephrology ◽

10.5414/cn107905 ◽

2013 ◽

Vol 80 (10) ◽

pp. 256-262 ◽

Cited By ~ 9

Author(s):

Robert M. Perkins ◽

H. Lester Kirchner ◽

James E. Hartle ◽

Ion D. Bucaloiu

Keyword(s):

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Renal Disease ◽

Glomerular Filtration ◽

End Stage Renal Disease ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Stage Renal Disease ◽

End Stage

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Pharmacokinetics of remdesivir in a COVID-19 patient with end-stage renal disease on intermittent hemodialysis

10.1101/2020.10.28.20216887 ◽

2020 ◽

Author(s):

Fritz Sörgel ◽

Jakob J. Malin ◽

Henning Hagmann ◽

Martina Kinzig ◽

Muhammad Bilal ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Renal Disease ◽

Glomerular Filtration ◽

End Stage Renal Disease ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Intermittent Hemodialysis ◽

Pharmacokinetic Assessment ◽

Stage Renal Disease ◽

End Stage

AbstractRemdesivir, a drug with provisional approval for the treatment of COVID-19, is not recommended in patients with an estimated glomerular filtration rate ≤ 30 mL/min. Here we provide a first detailed pharmacokinetic assessment of remdesivir and its major metabolites in a patient with end stage renal disease on hemodialysis.

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P5464Visit-to-visit glomerular filtration rate variability as a predictor for cardiovascular and renal outcomes in essential hypertension: Data from a Greek 8-year-follow-up study

European Heart Journal ◽

10.1093/eurheartj/ehz746.0419 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Laina ◽

C Tsioufis ◽

K Dimitriadis ◽

A Kasiakogias ◽

I Liatakis ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Renal Disease ◽

Glomerular Filtration ◽

End Stage Renal Disease ◽

Filtration Rate ◽

Left Ventricular ◽

Hazard Ratio ◽

Stage Renal Disease ◽

End Stage

Abstract Background/Introduction Renal dysfunction is related with adverse prognosis in hypertension, however there are scarce data on the predictive cardiovascular and renal impact of kidney function variability in this setting. Purpose The aim of the present study was to assess the predictive role of visit-to-visit renal function changes on the incidence of coronary artery disease (CAD), stroke and end-stage renal disease in a cohort of essential hypertensive patients. Methods We followed up 2380 essential hypertensives (mean age 58.9 years, 1240 males, office blood pressure (BP)=144/91 mmHg) free of cardiovascular disease for a mean period of 8 years. All subjects had at least one annual visit and blood sampling was performed in all visits for estimation of glomerular filtration rate (GFR). We calculated standard deviation (SD) of mean GFR from visits from 6 months onward in patients with ≥5 visits during follow-up. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure, while stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings. End-stage renal disease was defined as GFR<15 mL/min/1.73 m2 or the need for long-term dialysis or transplantation. Results The incidence of CAD, stroke and end-stage renal disease over the follow-up period were 2.8% (n=68), 1.09% (n=26) and 0.6% (n=14). Hypertensives who developed CAD compared to those without CAD at follow-up (n=2312) had at baseline higher left ventricular mass index (115.7±24.6 vs 103.7±27.3 g/m2, p<0.0001), whereas there was no difference with respect to baseline GFR (78±19.6 vs 79.3±18.6 mL/min/1.73 m2 (p=0.573). In multivariate Cox regression models visit-to-visit glomerular filtration rate predicted end-stage renal disease (hazard ratio=1.758, p=0.01) but not CAD and stroke (p=NS for both). Baseline left ventricular mass index independently predicted CAD (hazard ratio=1.042, p=0.015) and stroke (hazard ratio=1.035, p=0.002). Conclusions In essential hypertensive patients GFR variability predicts future development of end-stage renal disease but exhibits no independent prognostic value for CAD and stroke. These results suggest that fluctuations of renal function are related with damage at the kidneys and not at the cardiac and cerebrovascular level.

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