Average Glomerular Filtration Rate Research Articles

Ecografía Doppler renal con medición de índices de resistencia vs. gammagrafía renal con 99mTc-DTPA para el diagnóstico de estenosis ureteropiélica en niños

ObjectiveA cross-sectional study was carried out with the objective of evaluating the usefulness of Doppler ultrasound with resistive index (RI) measure compared with renal scintigraphy with 99mTc-DTPA in children with unilateral ureteropelvic junction obstruction. MethodsThe study included children under 15 years with a diagnosis of unilateral ureteropelvic junction obstruction, healthy contralateral kidney with or without an antecedent of ureteropyeloplasty. The selected patients were sent to the Nuclear Medicine Department to carry out a renal scintigraphy with 99mTc-DTPA and days later were sent to the Radiology Department for the performance of Renal Doppler Ultrasound with RI. ResultsA total of 21 patients were included in the study, 15 males and 6 females, representing 71.4% and 28.6%, respectively. Mean age was 5.3 years. Only 3 had an antecedent of ureteropyeloplasty in the affected kidney. The scintigraphy reported data of unilateral obstruction in 18 patients, including the 3 patients with previous surgery. The average glomerular filtration rate (GFR) obtained with the scintigraphy was 100.28ml/min. The average GFR in affected kidneys was 43.03ml/min and 57.24ml/min in healthy kidneys (p<.001). Doppler ultrasound with RI reported ectasia in 100% of the affected kidneys and one normal contralateral kidney. The average RI in affected kidneys was 0.69mm/s and 0.50mm/s in healthy kidneys (p<.001). ConclusionsWith the results obtained, we can suggest that ultrasound Doppler with measurement of RI can be an alternative tool to renal scintigraphy with 99mTc-DTPA in some cases.

Estimating glomerular filtration rate at the transition from pediatric to adult care

The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of the bedside creatinine-based Chronic Kidney Disease in Children (CKiD) equation to estimate glomerular filtration rate (GFR) in children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in adults. However, this approach causes implausible changes in estimated GFR (eGFR) at the transition from pediatric to adult care. We investigated the performance of the KDIGO strategy and various creatinine-based eGFR equations in a cross-sectional dataset of 5,764 subjects (age 10-30 years), using directly measured GFR (mGFR) as reference. We also evaluated longitudinal GFR slopes in 136 subjects who transitioned to adult care. Implausible changes in eGFR resulted from the large overestimation (bias=+21 mL/min/1.73m2) and poor precision of the CKD-EPI equation in the 18-20 year age group, compared to CKiD in the 16-18 year age group (bias=-2.7 mL/min/1.73m2), resulting in a mean change of 23 mL/min/1.73m2 at the transition to adult care. Averaging the CKiD and CKD-EPI estimates in young adults only partially mitigated this issue. The Full Age Spectrum equation (with and without height), the Lund-Malmö Revised equation, and an age-dependent weighted average of CKiD and CKD-EPI resulted in much smaller changes in eGFR at the transition (change of 0.6, -2.1, -0.9 and -1.8 mL/min/1.73m2, respectively). The longitudinal analysis revealed a significant difference in average GFR slope between mGFR and the KDIGO strategy (-2.2 vs.+2.9 mL/min/1.73 m2/year), which was not observed with the other approaches. These results suggest that the KDIGO recommendation for GFR estimation at the pediatric-adult care transition should be revisited.

Assessing the impact of inadequate hydration on isotope-GFR measurement

Guidelines state that patients undergoing isotope glomerular filtration rate (GFR) tests should maintain adequate hydration, but pragmatically these tests can coincide with procedures requiring the patient not to eat or drink (‘nil-by-mouth’) for up to 12 hours beforehand. This study investigated the impact of a 12-hour nil-by-mouth regime on GFR measurement. Twelve healthy volunteers were recruited from our institution. Exclusion criteria included diabetes mellitus, being under 18 years of age and pregnancy. Isotope GFR measurements were carried out on these volunteers twice. One of the tests adhered strictly to the British Nuclear Medicine Society (BNMS) guidelines for GFR measurement and the other test was carried out after the volunteers had refrained from eating or drinking anything for 12 hours. The order of these tests was randomly assigned. The results show that after a nil-by-mouth regime, participants’ average absolute GFR fell from 108 ml/min to 97 ml/min (p < .01), while normalised GFR fell from 97 ml/min/1.73 m2 to 88 ml/min/1.73m2 (p < .01). Serum creatinine rose from 68 mmol/L to 73 mmol/L (p < .05). There were no changes in blood pressure, serum hydration markers or bio-impedance measured fluid status. Urine analysis showed statistically significant increases in urea, creatinine and osmolality levels after the nil-by-mouth regime. The results highlight the importance of following current guidelines recommending fluid intake during the procedure. Practitioners should consider what other outpatient appointments are being scheduled concurrently with a GFR test.

Treatment With Grazoprevir/Elbasvir for Renal Transplant Recipients With Chronic Hepatitis C Virus Infection and Impaired Allograft Function.

BackgroundDirect-acing antiviral agents are highly efficient treatment options for chronic hepatitis C virus (HCV) infection after renal allograft transplantation. Treatment options for patients with impaired graft function remain limited. Therefore, we assessed the effectiveness and safety of grazoprevir/elbasvir therapy for patients with chronic HCV infection and impaired renal allograft function.MethodsEleven renal allograft recipients with therapy-naïve HCV genotype (GT) 1a, 1b, or 4 were treated with the fixed-dose combination of elbasvir/grazoprevir without ribavirin for 12 weeks. All recipients exhibited impaired graft function with an average glomerular filtration rate lower than 30 mL/min per 1.73 m2. Clinical data were retrospectively reviewed for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, viral load, laboratory values, and potential adverse effects.ResultsSeven (64%) patients exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 2; HCV GT1b, n = 5). The other 4 patients exhibited a virologic response within 8 weeks (HCV GT1b, n = 3; HCV GT 4, n = 1). All patients exhibited a sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Few adverse effects were reported. Impaired renal allograft function and proteinuria remained stable. For most patients, only moderate adjustments to the tacrolimus dosage were necessary for maintaining sufficient trough levels.ConclusionsThis treatment appears to be safe and effective for renal transplant recipients with impaired allograft function and is a promising treatment option for eradicating HCV infection in this patient population.

Profile of patients admitted for acute hypertensive heart failure

Acute heart failure is one of the most common hospitalization situations in the world. High blood pressure or so-called hypertensive heart disease is the second leading cause. The aim of this work is to study the epidemiological, clinical, and paraclinical profile of patients admitted for acute hypertensive heart failure. This is a retrospective study conducted on 350 admitted patients, in the cardiology department of Ibn Rochd CHU, for acute heart failure. We excluded patients admitted for emergency hypertensive hemorrhagic stroke type. The diagnosis was made on acute heart failure with high blood pressure at admission (more than 140 mmHg). Hypertensive emergency was noted in 88 patients or 25.1% of patients admitted for AHF. The average age was 61 ± 11 years with male predominance of 81%. Two-thirds of the patients were not known hypertensive. One-third of patients had diabetes, one-third had chronic tobacco and one-third had a history of myocardial infarction. Clinically, 56 patients with isolated left-ventricular hypertensive insufficiency, 18 patients had unstable angina associated, 12 patients had aortic dissection, 2 patients had hypertensive encephalopathy, mean systolic blood pressure was 230 mmHg, mean diastolic 140 mmHg. Signs of right heart failure were also present in 62% of cases. All patients had high filling pressures and grade II diastolic dysfunction in 53%. From a biological point of view, the average glomerular filtration rate was 50 mL/min/1.73 m 2 . Renal failure with GFR below 30 mL/min/1.73m 2 was marked in 60%. We did not notice any deaths in our series. the hypertensive emergency constitutes a quarter of the patients admitted for AHF. It occurs rather in an unknown population hypertensive characterized by the presence of the risk factors such as diabetes, tobacco and IDM ATCD. This syndrome poses in our context a problem of management of associated comorbidities.

Effects of Genetic Polymorphism on Susceptibility to Nephrotoxic Properties of BTEXs Compounds.

The aim of this study was to ascertain whether genetic polymorphism affects susceptibility of individuals to nephrotoxic potentials of benzene, toluene, ethyl-benzene, and xylenes (BTEXs). Fifty BTEXs exposed workers with one or more abnormal parameter of kidney function and 232 referent subjects, with similar exposure history, free from any abnormal kidney parameters were investigated. Atmospheric concentrations of BTEXs were measured. In addition, genetic polymorphisms were determined by multiplex polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP). The frequencies of GSTP1 Ile-Val/Val-Val, null GSTT1, and null GSTT1/GSTM1 genotypes and mean values of blood urea nitrogen and plasma creatinine were significantly higher, while average glomerular filtration rate was significantly lower in cases than in referent subjects. These findings indicate that individuals carrying null GSTT1 or null GSTT1/GSTM1 are more susceptible to nephrotoxic properties of BTEXs compounds.

Investigating the effect of atorvastatin drug on HbA1c in patients with myocardial infarction hospitalized in Farshchian Hospital, Hamadan province, Iran, in 2014-2015 (a before-after study)

Use of statins reduces the risk of cardiovascular diseases, however, in some studies, contradicting results about statins especially atorvastatin with the risk of diabetes have been reported. The purpose of the present study, was to investigate the effect of atorvastatin drug on HbA1c in patients with myocardial infarction hospitalized in Farshchian Hospital, Hamadan. 60 patients hospitalized in CCU, who were diagnosed with one type of infarction were included in this clinical trial performed as a before-after study. Demographic data were collected using a questionnaire. Before the study and 6 months after the start of the study, the parameters of lipid profile, HbA1c and GFR were measured. Atorvastatin with a dose of 80mg was given to the patients from the beginning of the study for 6 months. The results were analyzed using SPSS. The average age of the male and female patients was 63.83 and 61.11, respectively, which had an insignificant difference. 42 patients (70%) were male and the rest of them were female. Lipid profile results at the end of the study showed improved averages for the parameters, all of which were statistically significant compared to their values at the start of the study. The mean HbA1c increased from 6.19 to 6.43 (P=0.001), the mean fasting blood sugar increased from 103.66 to 110.51 (P=0.001), and the average glomerular filtration rate (GFR) decreased from 69.84 from the start of the study to 67.43 which was statistically significant (P=0.002). Systolic and diastolic blood pressure at the end of the study decreased compared to the start of the study where in systolic blood pressure, this decrease was significant (p=0.003). Based on the results of this study, although the use of atorvastatin reduces lipids, it may create the risk of hyperglycemia in these patients. However, a certain conclusion requires further studies.

Radioisotopic Evaluation Glomerular Filtration Rate (GFR) before and after Kidney Donation

Background Because of the decrease of the nephron mass following nephrectomy, kidney donors (KD) develop a partial loss of renal function defined as Acute Kidney Injury (AKI) according to KDIGO criteria (Clinical Practice Guideline, 2012). The recovery of renal function following AKI is mainly ascribed to the concept of renal functional reserve (RFR), defined as the capacity of the kidney to increase glomerular filtration rate (GFR). However, only few studies correlated RFR in KD with long term functional outcomes. Aim of the Study The aim of the present study was to analyse 30 KD renal function before nephrectomy, in the immediate postoperative period and 1 year after the surgical procedure, developing the concept of estimated RFR (eRFR) for the long term follow-up of renal function in KD. Results KD mean age at the time of donation was 54.4 years (min-max, 30-78), mean serum creatinine 0.73 mg/dL (0.5-0.96), eGFR (CKD-EPI) 99 mL/min/1.73m2 (69-119) and radioisotope (51Cr-EDTA) GFR 101.4 mL/min (78-129). The split function was evaluated by concomitant scintigraphy using 99mTc-MAG: the mean percentage of renal function of right kidney was 48% (43-56) and left 52% (44-57), respectively. As expected, immediately after nephrectomy all KD worsened renal function: the mean percentage increase of serum creatinine was 79% (50-112.2%) within 72 hours post-surgery; most of KD (25/30) developed AKI stage 1, and 5 KD AKI stage 2 according to KDIGO criteria. Seven days after surgery, renal recovery was observed in all cases: the mean percentage increase of serum creatinine (50.6%) was significantly lower than the zenith of serum creatinine. These results suggest a potential gain of about 30% in comparison to the starting value of the right kidney. One year after nephrectomy (all KD were subjected to left nephrectomies), we studied KD renal function (GFR) by radioisotopic evaluation using 51Cr-EDTA and we then compared it with the split radioisotope (51Cr-EDTA) GFR of the right kidney at the first scintigraphic evaluation. Mean GFR was 68.8 mL/min (50-87) vs. 48.6 mL/min (39.7-60.4) before donation with an average GFR increase of 20 mL/min (0.8-45.6) and a percentage increase of the right renal function up to 110% (mean 42%, min 1.4%). Conclusions The results of this study show that radioisotopic evaluation is feasible and allows an estimated determination of RFR at different time points after nephrectomy in KD. We observed a compensatory hypertrophy due to RFR in all the 30 KD included in the study, independently from age and co-morbidities such as elevated BMI and hypertension. The limitation of this study is the evaluation of RFR only after the decrease of the nephron mass due to donation: we have now started a kidney stress test with a protein load to estimate RFR of KD before surgery with the aim of finding a correlation with radioisotpic GFR after nephrectomy.

The effects of a sodium-glucose cotransporter 2 inhibitor on diabetic nephropathy and serum oxidized low-density lipoprotein levels.

To investigate the effect of an SGLT-2 inhibitor on diabetic nephropathy and serum oxidized low-density lipoprotein (ox-LDL) levels. We randomly divided 126 patients with diabetic nephropathy into the treatment group and control group. The 63 patients in the treatment group received an SGLT-2 inhibitor in addition to routine insulin therapy, while the control group received only insulin to control blood glucose. All laboratory indexes were recorded before and after treatment with the SGLT-2 inhibitor. The prognosis of patients was followed-up. Simultaneously, 63 healthy and BMI-matched in-patients were selected as the healthy control group. Peripheral blood samples were collected from all groups, and the levels of ROS were measured by ELISA. Renal function indexes such as urinary protein, creatinine, blood urea nitrogen, and glomerular filtration rate (GFR) were significantly higher with SGLT-2 inhibitor treatment compared with the control group (p<0.05). The fasting blood glucose level was not significantly increased before or after treatment (p>0.05). The levels of ROS in peripheral blood were significantly lower in the treatment group than in the control group (p<0.05). Observation at the 1-year follow-up showed that the average GFR was significantly higher in the treatment group than in the control group. Furthermore, the proportion of patients with stage 1-3 chronic kidney disease was significantly higher in the treatment group than in the control group (p<0.05). The SGLT-2 inhibitor had a good therapeutic effect on renal function in patients with diabetic nephropathy, without having effects on fasting blood glucose. Additionally, it significantly delayed the progression of nephropathy. It is therefore worth clinical promotion.

WITHDRAWAL OF ANGIOTENSIN ANTAGONISTS IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension guidelines worldwide recommend first-line treatment with Angiotensin Convertor Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) in almost all groups of patients. Nevertheless, some population as elderly or CKD patients at high risk to develop renal complications may benefit from avoidance of these commonly used drugs. Design and method: We reviewed our registry of out-hospital patients who had to suspend ACEI or ARBs treatment selecting those without kidney loss, known renal artery stenosis, active neoplasms or drug withdrawal in a condition of Acute Kidney Injury and we performed 12 months follow up. Finally, 36 resulting patients completed the one year period and data of basal, three months and 12-month visits have been compared. A case-control study examining the glomerular filtration rate (GFR), first-day urine albuminuria, blood pressure control and plasmatic potassium has been performed. Results: Baseline characteristics: 17 males and 19 females both with an average age of 78.3 (SD 7.7) years, Charlson's comorbidity index of 6.8 (SD 2), 14 treated previously with ACEI and 22 with ARBs. Comparison of average blood pressure, GFR, proteinuria and potassium levels showed: 1. There were no significant variations in blood pressure at 3 and 12 months. 2. GFR increased at 3 and 12 months from 31.9 (SD 9.4) to 39.6 (SD 14.9) and 43.1 (SD 17.3) ml/min/1.73m2 [p < 0.001] 3. Plasma potassium level decreased at 3 and 12 months from 5.1 (SD 0.6) to 4.7 (SD 0.5) and 4.6 (SD 0.5) mg/dl respectively [p < 0.001] 4. First-day urine albuminuria increased significantly at the 12-month visit in the overall group(from 127.4 (SD 301.8) to 233 (SD 557) mg/g, p < 0.05). Nevertheless, no significant change was observed in the group of 27 patients without significant previous proteinuria (from 13.9 (SD 16.8) to 21.5 (SD 24.8), p = 0.1 NS). Conclusions: Elderly patients with prolonged hypertension are at risk to develop slowly progressive kidney failure associated with the use of ACEI and ARBs, especially if renal atrophy is present. These patients without previous proteinuria would benefit from the first-line use of antihypertensive drugs without suppressive effect over the renin-angiotensin system.

Dépistage de la néphropathie dans les syndromes drépanocytaires majeurs chez les patients suivis au Centre national de référence de la drépanocytose de Niamey, Niger

BackgroundSickle cell anemia is the most common hereditary hemopathy in the world. It is a disease that attacks all the systems of the organism. The kidneys are among the most sensitive organs of this disease. The main objective of this study is to detect sickle cell nephropathy in patients followed at the National Reference Center for Sickle Cell Disease in Niamey. MethodsIt is a prospective study carried out over a period of one year (January to December 2016). It included patients aged at least two years who had not had a vaso-occlusive crisis (VOC) for 2 months and not transfused for at least 3 months. A questionnaire was sent to each patient to collect demographic, clinical and biological information. Each patient provided a fresh blood and urine sample to assess biological parameters. We used Schwartz's formula in children and CKD-EPI in adults to assess glomerular filtration rate. The Pearson correlation coefficient (r) was used to assess the relationship between the different parameters under study. The threshold for statistical significance was set at 0.05. ResultsTwo hundred and eighty participants were included in the study. Adolescents (≤17years) were 226 (80.71%) and adults were 54 (19.29%). The mean age of the patients was 11.94±4.70years. It was lower in SS subjects and higher in SC. The SS form accounted for 87.5% of the three sickle cell disease phenotypes encountered. The age group 6–15years was the most predominant (42.86%). The mean baseline hemoglobin in the sample was 7.59±1.15g/dL ; (6.8 ±0.9d/dL) in SS patients and higher (10.5±2.1g/dL) in SC patients. The average glomerular filtration rate was 201.04mL/min/1.73m2. Glomerular hyperfiltration was found in 90% of the sample, it was lower (77.6%) in Sβ thalassemia patients (P=0.000). In young subjects hyperfiltration was present in 84.95% against it was observed in only 29.63% of adults. Proteinuria was positive in 20% of patients. Positive proteinuria was found in 6.20% pediatric cases. The SC form was the most affected and in 74.6% of the patients it was positive at 1+. Chronic kidney disease (CKD) was found in 10% of the participants, of whom 75% were of the SS phenotype. Sβ thalassemia subjects had no CKD. The male sex was predominant in subjects with CKD (P=0.000). Patients over 15 years of age accounted for more than 95% of patients in both forms of the disease (P=0.0001). ConclusionThe SS form of the disease, recurrent vaso-occlusive crisis, male sex and advanced age were the main precipitating factors in the development of renal function disorders.

Usefulness of left ventricular mass change to predict progression of renal dysfunction in Hispanics

ABSTRACTThere is a strong relation between metabolic syndrome (MetS) and left ventricular (LV) mass in Hispanic patients. This population also tends to have a higher incidence of kidney disease, with progression to dialysis. We analyzed the change in LV mass in 982 Hispanic patients with MetS and used these data to anticipate the progression of renal dysfunction. Glomerular filtration rate (GFR) was calculated using the formula described by the Chronic Kidney Disease Epidemiology Collaboration. Echocardiographic data were collected using 2-dimensionally guided M-mode echocardiography measures. The data collected were then analyzed using linear regression analyses. Results showed a lower average GFR in individuals classified as having a severe change in LV mass in comparison to those with milder change in LV mass (P < 0.0001). This relation was also demonstrated when those with severe change in LV mass were compared with the control group (P < 0.0001). In those ≥54 years old, the presence of MetS and LV mass were negatively correlated with GFR (regression coefficient [RC] = 14.76, P < 0.063; RC = 0.11, P < 0.0001 respectively). In patients <54 years old, no statistically significant association between the presence of MetS and GFR was seen. However, LV mass was once again negatively correlated with GFR (RC = 0.15, P < 0.0001). In conclusion, results demonstrated the association between the MetS, change in LV mass, and chronic kidney disease progression.

Relationship between Obesity, Serum Uric Acid, Serum Potassium and Glomerular Filtration Rate with Electric Left Ventricular Hypertrophy in Blacks Central Africans with High Blood Pressure

The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum potassium with left ventricular hypertrophy (LVH) and obesity. This study enrolled 122 patients including 63 women (51.6%). The mean age was 55.9 ± 10.6 years (range 30 to 74 years). Obesity weight was found in 38 cases (31.1%) of which 20 were men (33.9%) and 18 women (28.6%). Abdominal obesity was found in 104 cases (85.2%). The average serum uric acid in patients with obesity weight was 63.3 ± 18.9 mg/L vs 62.4 ± 14.2 mg/L for no-obese patients (p = 0.63). The average serum potassium in obese patients was 4.06 ± 0.42 mEq/L vs 4.02 ± 0.46 mEq/L for no-obese (p = 0.65). The average GFR was 73.4 ± 21.4 ml/L in obese patients vs 66.6 ± 22.6 ml/min in no-obese (p = 0.03). The LVH was found in 81 cases (66.4%). The LVH was found in 65 (62.5%) obese patients vs 16 (88%) non-obese patients (OR = 4.8, 95% 1.04 - 22 p = 0.02). Only abdominal obesity has been correlated with left ventricular hypertrophy after multivariate analysis. Emphasis must be focused on public health actions for effective and appropriate measures against obesity and hypertension, whose prevalence is increasing in our region.

Fibrogenesis in Kidney Transplant: Dysfunction Progress Biomarkers

IntroductionFibrogenesis markers, such as alpha-actin (AA), CD163 (macrophages), and E-cadherin, have been studied as chronic kidney allograft injury (CAI) predictors, a major cause of allograft failure. ObjectiveInvestigate the value of these markers in predicting CAI and initiation of dialysis. Materials and MethodsRetrospective analysis of 26 kidney allograft biopsies (from 22 patients with CAI) during 2 years, evaluating intensity and percentage of marked cells on glomeruli and tubulointerstitial compartment. At the time of the biopsy, patients were 45.5 ± 15.8 years and 4.2 years after transplant, and they had a mean glomerular filtration rate (GFR) of 25.8 ± 9.9 mL/min. From an average of 8.5 glomeruli per biopsy, there was ≤25% sclerosis in 17 cases, 26% to 50% in 5, and >50% in 4. Interstitial fibrosis or tubular atrophy affected ≤25% of cortical area in 14 cases, 26% to 50% in 8, and >50% in 2. Twelve patients started dialysis 5.8 ± 4.7 years after transplant, with an average GFR 20.9 mL/min at the time of the biopsy. ResultsThere was a higher intensity and percentage of CD163-marked cells in the tubulointerstitial compartment in advanced interstitial fibrosis. We found an association between intensity of AA in the tubulointerstitial compartment and initiation of dialysis (P = .003) and a negative correlation between intensity of E-cadherin loss and GFR (r = −0.56, P = .012). ConclusionsIn our study, intensity of tubulointerstitial AA was shown to be a predictor of initiation of dialysis, and E-cadherin loss intensity was associated to CAI progression. However, prospective and larger studies are needed to evaluate the predictive value of these markers.

Senescent chronic kidney disease: The challenges faced and the strategies to overcome.

The management of chronic kidney disease (CKD) in elderly patients continues to pose constant challenges to clinical nephrologists. Right from the perplexing issue of calculating the glomerular filtration rate (GFR) to the confusion between the choice of disease-oriented approach and individual-centered approach, the challenges faced are mammoth. This article seeks to bring a consensus in sorting out these practical problems so that a systematic way of approach could be arrived at in managing such fragile patients. The last decade has seen an evolution and ongoing refinement of a disease-oriented approach to CKD. Since the average GFR tends to decrease with age, CKD becomes increasingly prevalent with advancing age, and thus, disproportionately elderly patients meet the criteria for CKD.

Clinical, laboratory, and morphological characteristics of kidney damage in lymphoproliferative disorders

Kidney involvement in the onset of lymphoproliferative diseases (LPD) detected rarely, observed mainly at tumor progression or relapse. Objective : to determine the clinical and morphological features of kidney damage in the initial manifestation of LPD. Materials and methods : 19 patients with LPD and kidney damage were included in the study. The diagnosis of non-Hodgkin’s lymphomas was established according to 2008 WHO classification. Histological and immunohistochemical, immunofluorescent and electron microscopic studies of nephrobiopsy have been performed. Results . Patients were aged 46-83 years (median 63 years), of which 13 were men and 6 women. Chronic lymphocytic leukemia / small cell lymphocytic lymphoma was established in 12 patients, marginal zone lymphoma – in 4 pts, follicular lymphoma – in 1 patient, Waldenstrom's macroglobulinemia – in 1 patient and diffuse large B-cell lymphoma (DLBCL) in 1 patient. Proteinuria was observed in 18 patients, microhematuria – in 6 pts, arterial hypertension – in 8 pts, nephrotic syndrome – in 3 pts and renal failure in 18 patients. The mean creatinine level was 330.9 ± 52.3 µmol/L, the average glomerular filtration rate was 25.7 ± 12.9 ml/min. Monoclonal IgMκ secretion was detected in 6 patients, BJκ protein – in 9 pts, increased free light chain level – in 4 pts, cryoglobulin – in 4 pts (type II cryoglobulin in 3 of them, type I – in 1 patient). Morphological study of nephrobiopsy revealed tumor lymphoid infiltration of kidney interstitium in 10 (52.6 %) cases. Diffuse small cell lymphoid proliferation was detected in 1 patient, local infiltration – in 9 pts, in 3 of them in combination with glomerulonephritis, and in 4 cases with kidney carcinoma. Local large cell lymphoid proliferation was found in 1 patient with DLBCL. Amyloidosis was detected in 2 pts and thrombotic microangiopathy – in 2 patients. Glomerulopathy was revealed in 10 patients (52.6 %): mesangioproliferative glomerulonephritis (MPGN) – in 4, mesangiocapillary glomerulonephritis – in 3, fibrillar glomerulonephritis (FGN) – in 1, immunotactoid glomerulonephritis – in 1, and glomerulonephritis with minimal changes – in 1 patient. Conclusion . Kidney damage in the onset of lymphatic tumor does not always manifest with proteinuria, hematuria, nephrotic syndrome and renal failure. In most cases, secretion of BJ protein, free light chains, monoclonal immunoglobulin and cryoglobulin are detected. Morphological changes are heterogeneous, including lymphoid proliferation, various types of glomerulopathies, amyloidosis and thrombotic microangiopathy.

Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis

ObjectivePercutaneous mechanical thrombectomy (PMT) is regularly used in the treatment of both venous and arterial thrombosis. Although there has been no formal report, PMT has been linked to cases of reversible postoperative acute kidney injury (AKI). The purpose of this study is to evaluate the risk of renal dysfunction in patients undergoing PMT vs catheter-directed thrombolysis (CDT) for treatment of an acute thrombus. MethodsThis study is a retrospective review of all patients in a single institution with a Current Procedural Terminology code for PMT or CDT from January 2009 through December 2014. Each patient was grouped into one of the four following procedural categories: PMT only, PMT with tissue plasminogen activator (tPA) pulse-spray, PMT with CDT, or CDT only. Preoperative and postoperative creatinine and glomerular filtration rate (GFR) values were obtained for each patient. The RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease) criteria were used to categorize the extent of renal dysfunction. χ2 analysis, one-way analysis of variance, and unpaired t-test were used to assess significance. ResultsA total of 227 patients were reviewed, of which 82 were excluded due to either existence of preoperative AKI, history of end-stage renal disease, or lack of clinical data. Of the remaining 145 patients, 53 (37%) presented with arterial thrombosis (mean age, 62 years; 43% male) and 92 (63%) presented with venous thrombosis (mean age, 48 years; 45% male). The incidence of renal dysfunction was highest in the PMT/tPA pulse group (21%), followed by the PMT group (20%) and the PMT/CDT group (14%). CDT was not associated with renal dysfunction. PMT (P = .046), and PMT/tPA pulse (P = .033) were associated with higher rates of renal dysfunction than the CDT controls. The average preoperative GFR for the 22 patients who developed AKI was 53.7 ± 9.4 mL/min/1.73 m2. The minimum postoperative GFR within 48 hours was an average of 35 ± 16 mL/min/1.73 m2. Stratified by the RIFLE criteria, 13 (9%) patients progressed to the risk category, 6 (4%) progressed to the injury category, and 3 (2%) progressed to the failure category. None of the patients who developed renal dysfunction from PMT progressed to dialysis within the same admission period. ConclusionsThe use of PMT as a treatment for vascular thrombosis is associated with renal dysfunction. Patients treated with PMT require postoperative vigilance and renal protective measures.

Applicability of the Schwartz Equation and the Chronic Kidney Disease in Children Bedside Equation for Estimating Glomerular Filtration Rate in Overweight Children.

To determine if significant correlations exist between glomerular filtration rate (GFR) prediction equation values, derived by using the original Schwartz equation and the Chronic Kidney Disease in Children (CKiD) bedside equation with a 24-hour urine creatinine clearance (Clcr ) value normalized to a body surface area of 1.73 m(2) in overweight and obese children. Prospective analysis (20 patients) and retrospective analysis (43 patients). Pediatric inpatient ward and pediatric nephrology clinic at a comprehensive academic medical center. Sixty-three pediatric patients (aged 5-17 years), of whom 27 were overweight (body mass index [BMI] at the 85th percentile or higher) and 36 were not overweight (BMI lower than the 85th percentile [controls]) between 2007 and 2012. Data from the overweight patients were compared with nonoverweight controls. GFR values were calculated by using the original Schwartz equation and the CKiD bedside equation. Each patient's 24-hour urine Clcr value normalized to a body surface area of 1.73 m(2) served as the index value. A Pearson correlation coefficient model was used to determine association between the 24-hour urine Clcr value (index value) with the Schwartz and CKiD GFR estimations. Significant correlation was found to exist between the Schwartz and CKiD bedside GFR estimations relative to the 24-hour urine Clcr in the control subjects (r = 0.85, p<0.0001, and r = 0.85, p<0.0001, respectively). Significant correlation was also found to exist between the Schwartz and CKiD bedside GFR values with the 24-hour urine Clcr value in overweight subjects (r = 0.86, p<0.0001, and r = 0.86, p<0.0001, respectively). The Schwartz equation estimated average GFR 21.75 ml/minute/1.73 m(2) higher than 24-hour urine Clcr (p<0.0001) in overweight children with a kidney disorder. The CKiD bedside GFR estimations were not significantly different compared with 24-hour urine Clcr values for the overweight group with kidney disorder (p=0.85). The Schwartz and CKiD bedside estimations of GFR correlated with 24-hour urine Clcr values in both overweight and nonoverweight children. Compared with the Schwartz equation, which tended to overestimate renal function, the CKiD bedside equation appeared to approximate 24-hour urine Clcr more closely in overweight children with kidney disorder.

Epidemiology of Renal Failure in Children at the Pediatric University Hospital Charles De-Gaulle of Ouagadougou (Burkina Faso)

Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) of Ouagadougou. Patients and Methods: We retrospectively studied all children aged from three to fifteen years old who were diagnosed with renal failure (RF) in the Department of Medical Pediatrics, from January 1, 2011 to December 31, 2013. RF was defined by a glomerular filtration rate (GFR) less than 80 mL/min/1.73m2, estimated by the formula of Pottel et al., which ignored the size that was rarely found in the medical records. The department constantly lacked pediatric blood pressure monitors or urinary strips. Results: In total, 119 cases of RF (3.3% of all admissions) were collected. They were about acute RFs (ARFs), chronic RFs (CRFs), and Unclassified RFs (URFs), respectively in 28.6%, 2.5% and 68.9% of cases. The overall average age of patients was 6.7 ± 3.4 years old. The average GFR was 35.2 ± 22.2 mL/min/1.73m2. The mechanism of ARF was presumed to be organic in 26 cases (76.5%). The most common presumed etiology was malaria (47.9%). Twelve patients (10.1%) died. Conclusion: RF was common at the PUHC-CDG but it was unclassified in over half of the cases. The diagnosis was based on the estimation of the GFR by Pottel et al.’s formula which was a good alternative to the Schwartz’s formula. The improvement of human and material resources would certainly help for a screening and characterization of RF at the PUHC-CDG.

Aging and low-grade inflammation reduce renal function in middle-aged and older adults in Japan and the USA.

The objective of this study was to investigate the effects of low-grade inflammation on age-related changes in glomerular filtration rate (GFR) in middle-aged and older white Americans, African-Americans, and Japanese adults. Serum creatinine, C-reactive protein (CRP), and interleukin-6 (IL-6) levels were determined for 1570 adult participants in two surveys of aging in the USA and Japan (N = 1188 and 382, respectively). Kidney function declined with age in both countries and was associated with IL-6 and CRP. IL-6 and CRP also influenced the extent of the arithmetic bias when calculating the GFR using the chronic kidney disease epidemiology (CKD-EPI) formula with just serum creatinine. Younger African-Americans initially had the highest GFR but showed a steep age-related decrement that was associated with elevated inflammation. Japanese adults had the lowest average GFR but evinced a large effect of increased inflammatory activity when over 70 years of age. Importantly, our results also indicate that low-grade inflammation is important to consider when evaluating kidney function solely from serum creatinine.