Calculation Of Glomerular Filtration Rate Research Articles

SEX-SPECIFIC DIFFERENCES IN RISK FACTORS AND THEIR CORRELATION IN PATIENTS WITH ESSENTIAL HYPERTENSION (STAGE III)

Aim.This paper is aimed at identifying risk factors (RFs) and assessing their correlation in men and women with essential hypertension (stage III) under medical treatment.Materials and methods.Ninety-eight patients (45 men and 53 women) with essential hypertension (stage III) were examined. All of them were divided into two groups by sex. Both groups were studied for risk factors (age, disease duration, body mass index), as well as the following indicators: blood lipids; blood glucose; total bilirubin and its fractions; alanine aminotransferase (ALT); aspartate aminotransferase (AST); blood creatinine with the calculation of glomerular filtration rate (GFR) using MDRD and CKD-EPI equations.Results.Sex-specific differences in RFs and their correlation in patients with essential hypertension (stage III) are presented. The frequency of comorbid pathology and associated conditions, as well as the amount of medication used by men and women is shown.Conclusion.Women are diagnosed with essential hypertension 4 years earlier; BMI values correspond to Class 1 obesity; GFR level corresponds to Stage 3 of chronic kidney disease; whereas men have higher levels of direct bilirubin, ALT and blood creatinine. Comorbid pathology is significantly more common in women, with diabetes mellitus being the most commonly detected such a pathology. The risk factor correlation in men and women is different, having a statistically significant multidirectional correlative relationship. All of the considered issues require further systematic study, as well as a rational approach to the prescription of medical therapy and the risk factor correction, taking the patient’s sex into account.

The state of renin-aldosterone system in patients with resistant arterial hypertension

Purpose. The understanding of pathophysiology and clinical characteristics of resistant hypertension (RH) remains elusive. The aim of this work was to study the relationships between clinical course of RH and levels of renin and aldosterone (AS). Materials and methods. A total of 47 patients with true RH were included in the study. The control group included 50 patients with controlled arterial hypertension (CAH). All patients underwent general clinical examination, calculation of body mass index (BMI), office blood pressure measurement, determination of plasma potassium, AS and active renin concentrations (ARC), assessment of plasma aldosterone-to-renin ratio, urinary albumin excretion, albumin-creatinine ratio (ACR), uric acid, serum creatinine, calculation of glomerular filtration rate (GFR) by Cockcroft–Gault formula, echocardiography. Results. AS and ARC levels were significantly higher (AS 145.21 ± 11.90 ng/ml and 122.04 ± 8.60 ng/ml, P < 0.001; ARC 18.21 ± 3.50 ng/ml and 14.40 ± 2.20 ng/ml, P < 0.05) in patients with RH compared to those with CAH, respectively. At the same time, among patients with RH, only 38 % had a normal ARC; increased ARC was in 27 % and reduced ARC was in 35 % of patients. Among patients with CAH, 78 % had a normal ARC; increased ARC was in 7 % and reduced ARC was in 15 % of patients. In patients with CAH, there was negative correlation between AS and ARC levels (r = -0.38, P < 0.05), at the same time in patients with RH, no correlation was found between AS and ARC levels. However, in patients with RH, there were negative correlations between AS, ARC and GFR (r = -0.36, P < 0.05; r = -0.32, P < 0.05, respectively); positive – ARC and left ventricular mass index (r = 0.43, P < 0.05); AS and ACR (r = 0.76, Р < 0.01); AS and left ventricular end-diastolic volume (r = 0.38, P < 0.05). Moreover, significant correlations were found between ARC and BMI (r = 0.59, P < 0.001), AS and BMI (r = 0.42, P < 0.05). Conclusions. The results indicate that in patients with RH, higher renin and AS levels are mediated by overweight as well as renin and AS have a different influence on target organs in RH. Furthermore, stimulation of AS production occurs regardless of the renin-angiotensin system and angiotensin II effects. The group of patients with RH is not homogeneous according to renin concentration and “low-renin” and “high-renin” hypertension are more frequently registered among them. It seems that pathophysiologic mechanisms are different in each case and need to be identified for the selection of antihypertensive agents to treat patients successfully.

Statin therapy among chronic kidney disease patients presenting with acute coronary syndrome

Background and aimsThe beneficial effect of statin therapy has been well established for both primary and secondary prevention of cardiovascular disease. Nevertheless, it remains under-used among patients with chronic kidney disease (CKD).We aimed to investigate the impact of statin therapy across a wide spectrum of CKD patients presenting with acute coronary syndrome (ACS). MethodsWe included all patients with ACS enrolled in the Acute Coronary Syndrome Israel Survey (ACSIS) between the years 2006 and 2016, and allocated them to 3 groups according to their renal function based on an estimated glomerular filtration rate (eGFR) calculation on admission (MDRD formula): eGFR<30 ml/min/1.73 m2 (n = 525, 6%), eGFR 30–59 ml/min/1.73 m2 (n = 1919, 21%), and eGFR>60 ml/min/1.73 m2 (n = 6501, 73%). Primary outcome included in-hospital, 30-day, and 1-year major adverse cardiovascular events (MACE), and the independent prognostic effect of statins among CKD patients with ACS, by Cox regression analysis. ResultsAll 8945 consecutive ACS patients were included in our analysis. On hospital discharge, statin prescriptions were negatively associated with eGFR ]eGFR>60 ml/min/1.73 m2 -95%, eGFR 30–59 ml/min/1.73 m2 -90%, eGFR<30 ml/min/1.73 m2 -78% (p < 0.001 for trend). Kaplan-Meier curves demonstrated both short and long-term higher mortality rates in those prescribed compared with those not prescribed statins (p < 0.001), regardless of renal function. Cox regression analysis revealed the protective effect of discharge statins (HR-0.25, 95% C.I 0.2–0.3, p < 0.001). ConclusionsIn our study, the beneficial effect of statins was maintained among CKD patients presenting with ACS. Therefore, these patients should be treated with statins regardless of their eGFR.

Evaluation of three Glomerular Filtration Rate (GFR) Equations Discriminates Stages of Chronic Kidney Disease (CKD) in Sudanese Patients

Background: Chronic kidney disease (CKD), represent a diagnostic challenge. CKD is an asymptomatic disease, tests for screening and early diagnoses are critical in nephrology. Objectives: To assess the potential role of a three glomerular filtration rate (GFR) calculation equations in discriminating between stages of chronic kidney disease (CKD) in Sudanese patients. Methods: The study was carried out at Khartoum State, Sudan from July 2017 to August 2017. Three hundred and seventy-five (375) CKD patients aged 18–90, their GFR have been estimated by three equations as follows: combined creatinine (cr) and cystatin C (cysC) equation (GFRcr-cysC), Modification of Diet in Renal Disease (MDRD) equation (GFRcr) and CystatinC-based equation (GFRcysC). The discriminating ability between stages was tested by ROC analysis. Results: The area under the receiver operating (AUC) curve values of the discriminated stages was tested by ROC analysis as the follows: between stage 1 and 2 were: GFRcr-cysC; 0.98 (p > 0.001), GFRcr; 0.77 (p 0. 001), GFR cr; 0.82 (p 0. 001), GFRcr; 0.92 (p 0. 001), GFRcr; 0.95 (p < 0.001) and GFRcysC; 0.65 (p < 0. 001). GFRcr-cysC had the highest AUC of all. Conclusion: Taking together, the study demonstrated that GFRcr-cysC equation is a valuable marker for early detection of CKD

CLINICO-LABORATORY CRITERIA FOR EVALUATING DYSFUNCTION OF KIDNEY ALLOTRASPLAT FOR THE OPTIMIZATION OF IMMUNOSUPRESS SCHEMES IN THE EARLY AND REMOTE PERIODS AFTER KIDNEY TRANSPLANTATION

Background. A significant role in solving the problem of renal replacement therapy should be played by kidney transplantation, which is now widely regarded as the optimal method for treating end-stage renal failure. An important problem remains the survival of the graft, and therefore it is necessary to find the most optimal method for diagnosing the earliest lesion of the graft.Objective. Examine the possibility of using glomerular filtration rate calculated by the Cockcroft–Gault (C&amp;G) and EPI formulas to assess renal allograft function.Design and methods. 216 patients with functioning renal allograft were examined, among them 92 women and 124 men, the average age was 56.8 ± 12.8 years. All patients completed: determination of serum creatinine level (Cr) (mmol/l), determination of the level of daily proteinuria (g/day), calculation of glomerular filtration rate using the formula EPI (ml/min) and Cockcroft–Gault formula (ml/min). All patients received immunosuppressive therapy.Results. We divided patients into 4 groups: 1 — patients without daily proteinuria with serum creatinine (Cr) &lt; 0.110 mmol/l, 2 — patients without daily proteinuria with Cr &gt; 0.110 mmol/l, 3 — patients with daily proteinuria less than 0.15 g/day with Cr &lt; 0.110 mmol/l, 4 — patients with daily proteinuria more than 0.15 g/day with Cr &gt; 0.110 mmol/l. The average Cr level was in the group 1 — 0.093 ± 0.001 mmol/l, in 2 — 0.162 ± 0.005 mmol/l, and 0.081 ± 0.002 mmol/l, and 0.135 ± 0.012 mmol/l in 3 and 4 groups, respectively. Glomerular filtration rate Cockcroft–Gault and EPI, respectively, in group 1 — 82.1 ± 4.4 ml/min and 74.9 ± 3.7 ml/min, in 2 — 55.3 ± 2.9 ml/min and 46.8 ± 2.4 ml/min, at 3 — 79.4 ± 2.8 ml/min and 71.1 ± 2.5 ml/min, at 4 — 51.2 ± 1.6 ml/min and 42.5 ± 1.2 ml/min. Сr level is not a sufficiently accurate indicator of allograft dysfunction, as in group 1 it was significantly higher than in group 3 (p &lt; 0.01), exactly the same picture was observed when comparing groups 2 and 4. At the same time, glomerular filtration rate using the Cockcroft–Gault formula and EPI formula was slightly higher in group 3 and 4 compared with group 1 and 2.Conclusion. Calculating glomerular filtration rate using the Cockcroft–Gault formula and EPI formula is a more sensitive method for assessing renal allograft dysfunction.

CLINICO-LABORATORY CRITERIA FOR EVALUATING DYSFUNCTION OF KIDNEY ALLOTRASPLAT FOR THE OPTIMIZATION OF IMMUNOSUPRESS SCHEMES IN THE EARLY AND REMOTE PERIODS AFTER KIDNEY TRANSPLANTATION

Background. A significant role in solving the problem of renal replacement therapy should be played by kidney transplantation, which is now widely regarded as the optimal method for treating end-stage renal failure. An important problem remains the survival of the graft, and therefore it is necessary to find the most optimal method for diagnosing the earliest lesion of the graft.Objective. Examine the possibility of using glomerular filtration rate calculated by the Cockcroft–Gault (C&amp;G) and EPI formulas to assess renal allograft function.Design and methods. 216 patients with functioning renal allograft were examined, among them 92 women and 124 men, the average age was 56.8 ± 12.8 years. All patients completed: determination of serum creatinine level (Cr) (mmol/l), determination of the level of daily proteinuria (g/day), calculation of glomerular filtration rate using the formula EPI (ml/min) and Cockcroft–Gault formula (ml/min). All patients received immunosuppressive therapy.Results. We divided patients into 4 groups: 1 — patients without daily proteinuria with serum creatinine (Cr) &lt; 0.110 mmol/l, 2 — patients without daily proteinuria with Cr &gt; 0.110 mmol/l, 3 — patients with daily proteinuria less than 0.15 g/day with Cr &lt; 0.110 mmol/l, 4 — patients with daily proteinuria more than 0.15 g/day with Cr &gt; 0.110 mmol/l. The average Cr level was in the group 1 — 0.093 ± 0.001 mmol/l, in 2 — 0.162 ± 0.005 mmol/l, and 0.081 ± 0.002 mmol/l, and 0.135 ± 0.012 mmol/l in 3 and 4 groups, respectively. Glomerular filtration rate Cockcroft–Gault and EPI, respectively, in group 1 — 82.1 ± 4.4 ml/min and 74.9 ± 3.7 ml/min, in 2 — 55.3 ± 2.9 ml/min and 46.8 ± 2.4 ml/min, at 3 — 79.4 ± 2.8 ml/min and 71.1 ± 2.5 ml/min, at 4 — 51.2 ± 1.6 ml/min and 42.5 ± 1.2 ml/min. Сr level is not a sufficiently accurate indicator of allograft dysfunction, as in group 1 it was significantly higher than in group 3 (p &lt; 0.01), exactly the same picture was observed when comparing groups 2 and 4. At the same time, glomerular filtration rate using the Cockcroft–Gault formula and EPI formula was slightly higher in group 3 and 4 compared with group 1 and 2.Conclusion. Calculating glomerular filtration rate using the Cockcroft–Gault formula and EPI formula is a more sensitive method for assessing renal allograft dysfunction.

Screening Assessment of Renal Function Status in Healthy Smoking Volunteers

The study objective was to evaluate the renal function status in overall healthy smokers. Renal function status was studied in 61 apparently healthy smokers aged 21–64 years (49 males and 12 females). The evaluation included taking a history with the smoking status assessment, a physical examination with assessment of systolic and diastolic blood pressure, blood and urine biochemistry, and calculation of glomerular filtration rate (GFR; CKD-EPI, 2009). The period of observation lasted for 7 days. High blood pressure and obesity had no impact on the kidney function (p > 0.05). Healthy smoking volunteers initially had a high GFR and a “high-normal” urine albumin level as compared to the group of healthy non-smokers (р = 0.000 and р = 0.012, respectively). The risk analysis showed that smoking increased 11-fold the risk of hyperfiltration (RR = 11.1, CI 95% 1.57–76.51, p = 0.001) and 5-fold the occurrence of albuminuria (RR = 5.1, CI 95% 0.71–36.99, p = 0.009) in smokers without initial renal pathology as compared to never-smokers. Those who abstained from smoking showed a moderate decrease of albuminuria (p = 0.049). Systematic tobacco consumption contributes to the development of a renal dysfunction with the occurrence of albuminuria and hyperfiltration (GFR ≥ 125 ml/min/1.73 m2). Timely smoking cessation promotes the regression of albuminuria.

The relationship of hypertriglyceridemia and left ventricular remodeling types in patients with chronic kidney disease

To assess the relationship between hypertriglyceridemia (THG) and left ventricular remodeling types in patients with chronic kidney disease(CKD). A total of 152 patients with CKD from stages 1 to 3 were examined, 98 of them with CKD without THG (subgroup 1) and 54 with CKD and THG. All patients were assessed for the parameters of anthropometry, hemodynamics, lipid spectrum, uric acid, calcium, C-reactive protein (CRP), and serum cystatin C measurement with calculation of glomerular filtration rate. The parameters of vascular stiffness (augmentation index and stiffness) and echocardiography are analyzed. In the 2nd subgroup (CKD + THG), the number of patients suffering from type 2 diabetes, a stable form of coronary heart disease, gout, and their combination with hypertension, as well as cerebrovacular disorders and hyperuricemia was significantly higher compared with patients with CKD without GTG (p.

Comparison of automatic depth correction versus manual depth correction in the calculation of glomerular filtration rate in gates renal processing of diethylenetriaminepentaacetic acid renogram in prospective renal donors

Aim: The aim of the study was to compare the glomerular filtration rate (GFR) obtained by gates method of renal processing using automated system generated method (ASGM) of depth correction with manual depth correction method (MDCM), in prospective renal donors using 99m-Tc diethylenetriaminepentaacetic acid (DTPA) scintigraphy. Materials and Methods: Prospective interventional study involving 20 voluntary renal donors of age 26–65 years were included. 99m-Tc DTPA renograms were acquired by dynamic acquisition for 30 min. Presyringe and postsyringe counts, prevoid and postvoid images, and both sides of lateral images (for manual depth correction) were acquired. GFR was calculated by Gates renal processing with the depth correction both by ASGM and MDCM methods. Results: The mean depth of right and left kidneys calculated by MDCM and ASGM were 7.2 ± 1.1 and 6.4 ± 1.1 and 7.0 ± 1.2 and 6 ± 1.2, respectively. The mean total GFR calculated by Gate's Method using MDCM and ASGM was 96.2 ± 15.4 and 82.0 ± 11.5. There was a statistically significant difference in the depth correction of both kidneys and improvement in total GFR values by MDCM methods compared to the ASGM method. Conclusion: There was a significant difference in depth and GFR values, calculated from MDCM compared to ASGM. Hence, the MDCM is better in calculating GFR for renal donors, especially when using low-energy high-resolution collimators, as full-width half-maximum varies considerably for every centimeter of the distance of the source from the collimator.

Association of urinary activity of MMP-9 with renal impairment in Mexican patients with type 2 diabetes mellitus.

BackgroundDiabetic kidney disease is the most common cause of chronic kidney disease (CKD). An early event in diabetic kidney disease is alteration of the glomerular basement membrane and the mesangial expansion. Matrix metalloproteinases (MMP) are a family of endopeptidases responsible for controlling the pathophysiological remodeling of tissues, including renal tissues. MMP-9 in human urine has been proposed as a marker of diabetic nephropathy and urinary tract infections (UTI).MethodsA cross-sectional study was conducted in type 2 diabetes mellitus (T2DM) patients who receive first level medical attention in Mexico. We used ELISA to measure MMP-9 levels in the urine of subjects with T2DM ≥ 18 years of age, who fulfilled the clinical requirements for calculation of glomerular filtration rate (GFR), according to the K/DOQI guide, in an attempt to identify whether MMP-9 levels in T2DM differ in patients with and without renal impairment. Univariate and multivariable analyses were performed in order to identify the association between MMP-9 and renal impairment.ResultsIncluded in the study were 34 (45%) subjects with renal impairment and 42 (55%) without. In the group with renal impairment, 10 subjects corresponded to stages 1–2 and 24 subjects corresponded to stage 3, according to their values of GFR and urinary albumin, following that proposed by the K/DOQI. No differences were found relating to sex, age, having or not having a partner, education, being able to read and write a message and duration of T2DM. Moreover, no differences were found between the groups in terms of weight, height, body mass index, waist size in general and frequency of UTI. In contrast, serum creatinine and urinary albumin were higher in the group with renal impairment, while GFR was greater in the group without renal impairment. Levels of MMP-9 were greater in women compared to men. Through univariate analysis in the general population, the presence of MMP-9 and that of its percentile 90 (P90) P90 were associated with the renal impairment group; however, in patients without UTI, only the presence of MMP-9 was associated with the renal impairment group, and no association was found with its P90. Multivariate analysis revealed an association between MMP-9 and its P90 with renal impairment.DiscussionIt is necessary to validate sensitive and non-invasive biological markers of CKD. We demonstrate that the presence and P90 of urinary MMP-9 are associated with renal impairment in Mexican patients with T2DM. While high levels of MMP-9 were associated to females and UTI, the presence of UTI was not associated with the incidence of renal impairment.

Proteinuria as a Marker for Cardiovascular Disease in Renal (Chronic Kidney Disease) Patients

Abstract Background For the evaluation of total cardiovascular risk in patients with chronic kidney disease (CKD; renal), the amount of protein in the urine has to be considered an important factor. For reducing proteinuria level and lowering the risk of renal, cardiovascular endpoint, this may become a crucial decision. Materials and Methods This is a case-control study of the stage 5 CKD female patients recruited over 2 months in 2017, based on clinical and laboratory investigation. CKD was diagnosed on serum creatinine levels and stage 5 CKD depending on estimated glomerular filtration rate (eGFR) calculation. Coronary artery disease (CAD) was diagnosed on clinical history, electrocardiogram (ECG), and echocardiogram. Results This study was conducted on 50 patients at the authors’ hospital. Out of these, 25 were cases and 25 constituted controls. Out of 25 controls, 13 had microalbuminuria and 12 had proteinuria and no cardiovascular disease. Out of 25 cases, 2 cases had microalbuminuria and 23 had proteinuria. More number of CKD with CAD group had proteinuria than CKD without CAD, which was statistically highly significant (p &lt; 0.000). CKD patients with CAD had higher degree of proteinuria than those without CAD, which was statistically significant (p &lt; 0.005). Conclusion This study showed that proteinuria and its cardiovascular outcomes in CKD patients are correlated. For detection of CAD in CKD patients, proteinuria levels may be crucial regarding the treatment decision.

Results of qualitative test on fatty acid binding cardiac protein in suspected acute coronary syndrome and various kidney function level

Aim.To evaluate diagnostic properties of qualitative tests for cardiac fraction of the fatty acid binding protein (cFABP) in patients hospitalized with suspected acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) level.Material and methods.Totally, 465 patients included, admitted with ACS within 24 hours from onset. All patients underwent cFABP test with immune chromatographic express tests “CardioFABP” (Novosibirsk, Russia) and/or “CARD-INFO” (Obninsk, Russia), as the levels of serum creatinine with further GFR calculation. Assessment of diagnostic characteristics was done by the values of specificity, sensitivity, and diagnostic correctness, as well as overall positive and negative test results according to GFR.Results.The analysis did not reveal significant difference in the number of positive and negative results of cFABP with the “CARD-INFO” (χ2=6,822, р=0,146), “CardioFABP” 10 ng/mL (χ2=4,968, р=0,291) and “CardioFABP” 15 ng/mL (χ2=8,673, р=0,07) in comparison by GFR. With coupled comparison, in the groups of patients by GFR there were differences in specificity for “CARD-INFO” (Fischer criteria =0,017, р˂0,05) and precision for “CardioFABP” (10 ng/mL) (χ2=5,793, р=0,017) in patients by GFR levels 60-90 and 30-59 mL/min/1,73 m2. For the other parameters of diagnostical efficacy there were no differences by GFR. In severe renal dysfunction (GFR ˂15 mL/min/1,73 m2) results of qualitative cFABP were false positive in 10 cases among 11 (90,9%).Conclusion.In patients hospitalized for suspected ACS, the results and diagnostic characteristics of the express-tests for cFABP “CARD-INFO” and “CardioFABP” depended mildly on GFR level with its values ≥15 mL/min/1,73 m2. Low number of patients with GFR ˂15 mL/min/1,73 m2made not possible to acquire significant data on cFABP in this category of patients, however the data available make it not to apply the test in this category of patients.

Correlations and Differences in Glomerular Filtration Rates Calculated Through In-House and Non-In-House Workstations of Scintigraphic Gamma Cameras

Background: Technetium-99m diethylene triaminepentaacetic acid (Tc-99m DTPA) renal scintigraphy using modified Gate’s method is commonly adopted to calculate glomerular filtration rate (GFR). Objectives: The purpose of this study was to find the correlations between GFRs, which are calculated by the in-house and non-in-house workstations from gamma cameras (GC) manufactured by different firms. Patients and Methods: Medical records of patients receiving Tc-99m DTPA renal scan between January and December 2016 were analyzed. Patients were allocated randomly to a GC (1 or 2). The calculated GFRs were conducted by the in-house workstation (group A: workstation 1/ GC 1; group B: workstation2/ GC 2) and the non-in-house workstation from the GC (group C: workstation 2/ GC 1; group D: workstation 1/ GC 2). All patients had their creatinine levels checked to calculate the estimated GRF (eGFR) as the reference data. Comparison of correlation and difference between GFR calculations (group A, B, C and D), eGFRs and clinical parameters was analyzed. Results: Forty patients (24 men, 16 women) were enrolled in this study. The average of eGFRs was 63.0 ± 38.5 mL/min/1.73m2. The GFRs (group A to D) calculated were all significantly correlated with the eGFR. However, there was a significant difference between group C and eGFR (P = 0.0021), and group D and eGFR (P = 0.0262). Eight patients (20%) had changed stage of chronic kidney disease when using non-in-house workstations, compared to in-house workstations from GC. Conclusion: GFRs calculated by the non-in-house workstation were significantly different from eGFR. Use of workstation and GC from the same manufacturer would provide more accurate data in the clinical setting.

Clinical and functional characteristics of diabetic nephropathy in children

Objective: To determine the clinical and functional characteristics of kidney damage in diabetes mellitus (DM) type I in children to establish the criteria for the prediction and early diagnosis of diabetic nephropathy (DN). Patients and methods. A total of 125 patients 4–18 years with type 1 diabetes. Kidney function was assessed by determining serum cystatin C and calculation of glomerular filtration rate (GFR) using the formula Hawke. Results and discussion: the majority of patients with type 1 diabetes with the NAM, the median age was observed for 2.5 years more than in the comparison group (p &lt;0.01). The high risk of developing MD in children with early-onset disease (51.7% of cases – up to 5 years of life) and the duration of diabetes for over 10 years. Nam 100% combined with other disease complications: neuropathy, retinopathy. In patients with DN revealed lower values of birth weight: 3,100 (2800–3400) c. against 3280 (3100–3600) c. In assessing the physical development of children, more than half have a disharmonious physical development. Assessment of blood pressure levels revealed its increase in most of the patients with DN. The majority of patients with DN (72.4%) marked signs of dyslipidemia, which is significantly higher than in the comparison group (29.2%, p &lt;0.005). Conclusions: The risk factors for the formation of NAM in children are older than 15 years, disease duration of more than 10 years, presence of neuropathy, retinopathy, cataract, and combinations of these complications, low growth, hypertension, lipid spectrum of the blood plasma.

Assessment of Agreement between Gates Method and Dual Plasma Sample Method for Measurement of Glomerular Filtration Rate

&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; Glomerular filtration rate (GFR) is generally considered to be the best index of renal function in both healthy and diseased kidneys. Calculation of GFR plays a vital role in the management of patients having renal diseases. Clinicians can make their final decision regarding the potential need for kidney transplantation and also selection of a potential kidney donor. Many methods have been developed in order to obtain more accurate GFR values. The most popular radionuclide method is camera based Gates method using 99mTc DTPA (Diethylene triaminepentaacetic acid). This method can provide immediate calculation of individual kidney function as well as of global renal function. But several sources of errors may reduce the reliability of this method. Measurement of multiple blood samples offers almost real values of GFR, which have become the gold standard in clinical research. The aim of this research work was to study the agreement between Gates method and dual plasma sample method for measurement of GFR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods:&lt;/strong&gt; This cross sectional study was carried out in National Institute of Nuclear Medicine &amp;amp; Allied Sciences (NINMAS), during July 2015 to June 2016. A total of 59 patients were included in this study. GFR was estimated by both the camera based Gates method and dual plasma sample method (DPSM).Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The mean values were calculated for continuous variables. Categorical data were expressed in percentage and number. Pearson correlation and Bland &amp;amp; Altman (B &amp;amp; A) analyses were applied for assessing correlation and agreement between Gates method and DPSM. Degree of relation between the variables is expressed by r (Pearson’s correlation coefficient).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean GFR evaluated by Gates method was found 82.2 ± 27.4 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; and mean GFR by DPSM was found 82.8 ± 24.1 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;. A strong positive correlation (r = 0.833; p = 0.001) was found between the GFR values measured by Gates method and DPSM. With Bland and Altman analysis, it was observed that mean difference of GFR measured by Gates method and DPSM was – 0.6 ± 15.22 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;. The limit of agreement ranged from – 30.44 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; to 29.24 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; There was strong positive correlation between Gates method and DPSM for measurement of GFR. Mean difference between the methods was small. The bias between the methods was considered not significant. The differences within mean ± 1.96 SD are not clinically important. Hence Gates method and DPSM can reflect GFR almost equally and can be used interchangeably.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(1): 19-23, January 2017&lt;/p&gt;

Carboplatin Dosing Accuracy by Estimation of Glomerular Filtration versus Creatinuria in Cancer Patients

Background: The glomerular filtration rate (GFR) is essential for calculating the dose and the monitoring of carboplatin. Although GFR measurement (mGFR) by external markers is ideal, in most cases these are not employed; the most used method is GFR estimation (eGFR) by formulae, hence the need to identify the formula with the best performance. Methods: Patients admitted between 2011 and 2017 and diagnosed with ovarian, endometrial, lung, esophageal, or testicular cancer were assessed retrospectively. The accuracy of the carboplatin dose calculated by creatinine concordance and by the Cockroft-Gault (CG), CKD-EPI, MDRD, Wright, and Jelliffe formulae was assessed using the intraclass correlation coefficient. Results: Fifty-six medical histories were analyzed. The best accuracy was observed between the Wright formula (i.e., 0.71) and the dose calculated based on the 24-h creatinine clearance. Stratification by CKD was made in depurations < 60 mL/min, where the Jelliffe value was excellent (i.e., 0.75). In depurations ≥60 mL/min, CKD-EPI was the best formula, with an accuracy of 0.65. CG was the formula with the worst performance in calculating the dose and glomerular filtration, losing its usefulness with very low filtrations. Conclusions: GFR formulae and calculation of the carboplatin dose have good accuracy with the GFR obtained based on the 24-h creatinine clearance, with the Wright formula being the one with best performance and CG the one with worst performance.

Biomarkers of kidney injury in hypertension: conventional versus novel

Objective. The aim of the present study was to compare conventional and novel, potentially earlier biomarkers of kidney injury in patients with different severity and duration of arterial hypertension (HTN) and healthy controls. Design and methods. Urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule‑1 (KIM‑1), liver fatty-acid binding protein (L‑FABP), albuminuria and serum levels of cystatin C and creatinine were measured in 92 hypertensive patients (46 male, mean age 50,7 ± 12,2 years) and 34 healthy control subjects (16 male, mean age 49,9 ± 11,4 years). Hypertensive patients were divided into four age- and sex-matched groups according to HTN severity: 1st grade (n = 24), 2nd grade (n = 26), 3rd grade (n = 17) and resistant hypertension (n = 25). Glomerular filtration rate (GFR) was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure (BP), 24‑hour ambulatory BP monitoring (ABPM, SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic pressure. Results. As compared to healthy control subjects, hypertensive patients were characterized by higher creatinine and albuminuria levels, and lower GFR, however, creatinine levels remained within the normal range despite the increase in the severity of HTN. Levels of albuminuria increased only in patients with severe HTN. Also as compared to healthy controls, HTN patients had significantly higher levels of cystatin C, which already was found in patients with 1st and 2nd stages of HTN, which occurs more often than an increase of creatinine and albuminuria levels. Patients with HTN had significantly lower sCys-estimated GFR and creatinine-sCys-estimated GFR. In HTN patients these biomarkers were associated with office systolic BP (SBP), central aortic systolic and diastolic (CAP) and mean 24‑hour BP level. There were no differencesin NGAL, KIM‑1 levels between the groups, however, KIM‑1 levels were associated with office SBP, mean daily 24‑hour of diastolic BP (DBP) and systolic and diastolic CAP in patients with severe HTN. At the same time, as compared with healthy controls, patients with initial HTN were characterized by higher levels of urine L‑FABP and its concentration increased in patients with severe HTN. In addition, L‑FABP levels were associated with office SBP and DBP, mean 24‑hour BP and systolic and diastolic CAP. Conclusions. The simultaneous assessment of creatinine and cystatin C levels, and the calculation of GFR using the formula CKD-EPI seems to be more accurate method for CKD stage classification in general and, in particular, in hypertensive patients; in hypertensive patients L‑FABP appears to be earlier biomarker of kidney injury, reflecting the progression of tubulointerstitial injury.

MONITORING OF THE EFFICACY AND SAFETY OF HIGH-DOSE ATORVASTATIN IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Aim. To study the effectiveness of achievement of lipid profile target levels and safety of therapy with atorvastatin in different doses in patients with acute ST-segment elevation myocardial infarction (STEMI). Material and methods. The open prospective controlled single-center study included 90 patients with STEMI aged 32 to 65 years. In the first 24-96 hours from the disease onset the patients were randomized into two groups: the first group included 43 patients who received high-dose statin therapy – atorvastatin 80 mg/day (Group 1), the second group (Group 2) – 47 patients receiving atorvastatin 20 mg/day. Examination of patients with STEMI included the assessment of plasma lipid profile, blood levels of hepatic transaminases, creatine phosphokinase (CPK), C-reactive protein (CRP), brain natriuretic peptide (BNP), creatinine, glucose and glomerular filtration rate calculation. Results. A decrease in the level of low density cholesterol (LDC) by 52.4% (p 50% from the baseline – in another 26%. LDC decreased by 33% in Group 2 (p 50% – in 15% of patients. After 24 weeks, a statistically significant decrease in hepatic transaminase activity was found in the both groups in comparison with the baseline level. The level of CRP decreased 9.1 times (p<0.001) in Group 1, and 7.8 times (p<0.001) – in Group 2. Reduction in the level of BNP was also found in Group 1 by 60% (p=0.005), and in Group 2 – by 33.8% (p<0.001). The levels of CPK, creatinine and GFR in the both groups did not change. A comparable decrease in fasting glycemia was found after 24 weeks in the both groups. Conclusion. The revealed lipid-lowering and pleiotropic effects confirm the necessity of using atorvastatin 80 mg. The absence of changes in the level of transaminases, CPK, serious adverse effects indicates the safety of the use of high-dose statin therapy in STEMI patients for the secondary prevention of cardiovascular events.

A Comparison of GFR Estimation Formulae in Pediatric Oncology

Application of potentially nephrotoxic chemotherapy requires continuous monitoring of renal function for toxicity and dosing. Novel pediatric glomerular filtration rate (GFR) estimating equations including cystatin C have been proposed to enhance the reliability of GFR calculation. We examined a pediatric oncologic data set with a total of 363 GFR measurements. An analysis of distribution characteristics and comparison of medians was performed to compare creatinine and cystatin C-based GFR estimating formulae. Furthermore, we investigated the clinical impact of different equations in regard to therapeutic consequences. Significant differences in estimated GFR values were calculated depending on the applied formula (range of median GFR from 94.8 to 180.9 mL/min per 1.73 m2) which may result in different therapeutic consequences for the use of potentially nephrotoxic chemotherapeutic agents. Significant correlation for all examined formulae was identified, however there were large fluctuations among the correlation coefficients ranging from 0.254 to 1.0. This study compares proposed pediatric GFR estimating equations in a clinical setting. It underlines the current limitations and difficulties of GFR estimation including potential dosing errors. Cystitis C-based equations can be used as alternatives to creatinine-based estimations when the appropriate laboratory method has been applied. A comparative calculator for pediatric GFR estimating equations along with background information is provided at http://gfr.pedz.de and may support clinical decision-making.

Calculation of Glomerular Filtration Rate from Renal Volume in Kidney Donors using Herts’ Formula

Calculation of Glomerular Filtration Rate from Renal Volume in Kidney Donors using Herts’ Formula