Lower Mean Glomerular Filtration Rate Research Articles

Pattern and predictors of urine protein excretion among patients with type 2 diabetes attending a single tertiary hospital in Lagos, Nigeria.

Testing for proteinuria is used to screen for diabetic nephropathy. However, significant proportion of diabetics has normal urine protein excretion despite impaired renal function. We aimed to determine the factors predicting increased urine protein excretion in patients with type 2 diabetes. This was a cross-sectional study of 358 type 2 diabetics attending the diabetes clinic of a teaching hospital in Lagos. Data regarding patients' demographic characteristics, and disease history were retrieved. Clinical measurement and samples for determination of plasma creatinine, and urine protein/creatinine ratio were obtained. Comparison of means was by student's t-test, while for percentages, Chi-square test was used. Relationship between glomerular filtration rate (GFR) and urine protein excretion was assessed using linear regression while factors associated with increased urine protein was determined excretion logistic regression analysis. Level of statistical significance was set at P <0.05. Mean age was 57.84 + 11.12 years and mean duration of diabetes was 8.63 + 7.53 years. Urine protein excretion was increased in 191 (53.4%) of the patients. Patients with increased urine protein excretion were more likely to be hypertensive, to be on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker had a higher mean systolic blood pressure, and a lower mean GFR. Patients with a GFR <60 mL/min/1.73 m2 had a six-fold increased odds of having increased urine protein excretion, while patients on an inhibitor of the renin-angiotensin-aldosterone system had a 50% reduced odds of having increased urine protein excretion. Proteinuria and reduced GFR are common among sub-Saharan African patients with type 2 diabetes. GFR below 60 mL/min/1.73 m2 and not receiving an inhibitor of the renin-angiotensin-aldosterone system predict increased urine protein excretion in them.

Effect of birth weight on adulthood renal function: A bias-adjusted meta-analytic approach.

While the association between low birth weight (LBW; <2500 g) and development of adult chronic renal disease (CKD) is inconsistently reported, less information is available regarding association of high birth weight (HBW; ≥4000 g) with CKD. We undertook a systematic review and meta-analysis on studies published before 30 September 2015 and report associations between birth weight and renal function. Blood (glomerular filtration rate (GFR)) and urine (microalbuminuria/albumin excreation rate (AER)/urinary albumin creatinine ratio (ACR)) parameters were used to define CKD. Three different effect size estimates were used (odds ratio, regression coefficient and mean difference). The odds of developing CKD in the life course among those born LBW was 1.77 (95% CI: 1.42, 2.20) times and 1.68 (1.27, 2.33) times, assessed by blood and urine parameters respectively. Higher risk was also observed among Asian and Australian populations (blood: OR 2.68; urine: OR 2.28), individuals aged ≤30 years (blood: OR 2.30; urine: OR 1.26), and ≥50 years (blood: OR 3.66; urine: OR 3.10), people with diabetes (blood: OR 2.51), and aborigines (urine: OR 2.32). There was no significant association between HBW and CKD. For every 1 kg increase in BW, the estimated GFR increased by 2.09 mL/min per 1.73 m(2) (1.33-2.85), and it was negatively associated with LogACR (ß -0.07, 95% CI: -0.14, 0.00). LBW inborn had lower mean GFR -4.62 (-7.10, -2.14) compared with normal BW. Findings of this study suggest that LBW increased the risk of developing CKD, and HBW did not show any significant impact.

Prevalence and determinants of periodic limb movements in the general population.

Periodic limb movements during sleep (PLMS) are sleep phenomena characterized by periodic episodes of repetitive stereotyped limb movements. The aim of this study was to describe the prevalence and determinants of PLMS in a middle to older aged general population. Data from 2,162 subjects (51.2% women, mean age = 58.4 ± 11.1 years) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Assessments included laboratory tests, sociodemographic data, personal and treatment history, and full polysomnography at home. PLMS index (PLMSI) was determined, and PLMSI > 15/h was considered as significant. Prevalence of PLMSI > 15/h was 28.6% (31.3% in men, 26% in women). Compared to subjects with PLMSI ≤ 15/h, subjects with PLMSI > 15/h were older (p < 0.001), were predominantly males (p = 0.007), had a higher proportion of restless legs syndrome (RLS; p < 0.001), had a higher body mass index (p = 0.001), and had a lower mean glomerular filtration rate (p < 0.001). Subjects with PLMSI > 15/h also had a higher prevalence of diabetes, hypertension, and beta-blocker or hypnotic treatments. The prevalence of antidepressant use was higher, but not statistically significant (p = 0.07). Single nucleotide polymorphisms (SNPs) within BTBD9 (rs3923809), TOX3 (rs3104788), and MEIS1 (rs2300478) genes were significantly associated with PLSMI > 15/h. Conversely, mean hemoglobin and ferritin levels were similar in both groups. In the multivariate analysis, age, male gender, antidepressant intake, RLS, and rs3923809, rs3104788, and rs2300478 SNPs were independently associated with PLMSI > 15/h. PLMS are highly prevalent in our middle-aged European population. Age, male gender, RLS, antidepressant treatment, and specific BTBD9, TOX3, and MEIS1 SNP distribution are independent predictors of PLMSI > 15/h.

0007 : Low left ventricle ejection fraction in STEMI's patients: experience of University Hospital of Casablanca

Heart failure is a clinical syndrome resulting from impaired function of the myocardium. This study sought to describe and compare specific characteristics, baseline clinical profile and intrahospital mortality of patients admitted in intensive care unit (ICU) for acute myocardial infarction with sustained STsegment elevation (STEMI) according to their left ventricle ejection fraction (LVEF). We included 79 patients over first quarter 2013. Patients with LVEF < 40% constituted group1 (n=22; 27.8%) and were compared to patients’ group2, n=57; 72.2% with LVEF ≥40%. For each patient, cardiovascular history, maximum Killip class, period chest pain, heart rate (HR), troponine level, kidney function and CRP were recorded. The average age was 59.6 years. Patients’ group1 were older: 64.4 years against 57.8 years for patients’ group2. Sex ratio did not differ with a male predominance 68% in both groups. Patients’ group1 were more frequently hypertensive (50% vs. 36.84%) and had history of coronary heredity in 9% of cases vs. 1.75% in group2. They presented in a shorter chest pain time (5.4 hours vs. 6.7 hours) and were more frequentely tachycardiac (HR≥100 bpm): 40.9% vs. 17.5% in group2. Patients in group 1 had significantly more congestive heart failure (22.72% of patients were ≥killip II vs. 1.75% in group2) (p = 0.006). Troponines were positive in 95% in both groups with an average of 47.01 ng/ml in group1 vs 42.38 ng/ml in group2. Group1 presented lower mean Glomerular Filtration Rate (GFR): 58,2ml/min vs 87,16mL/min and higher CRP (average 93.11mg/l vs 50.28mg/l in group2). The short term Survival was higher in group2 (94.74% vs 86.37%). Our study shows that older age, tachycardia, CHF, prior hypertensive, and higher CRP were more associated with moderate to severe impaired LVEF at admission in patients with STEMI. We think taht a rapid assessment of LVEF in the IUC will identify a population at risk who needs sharper hospital care.

Estimated visceral adipose tissue, but not body mass index, is associated with reductions in glomerular filtration rate based on cystatin C in the early stages of chronic kidney disease.

Information on the association between obesity and initial phases of chronic kidney disease (CKD) is still limited, principally those regarding the influence of visceral adipose tissue. We investigated whether the visceral adipose tissue is more associated with reductions in glomerular filtration rate (GFR) than total and abdominal obesity in hypertensive individuals with stage 1-2 CKD. A cross-sectional study was implemented which involved 241 hypertensive patients undergoing treatment at a primary health care facility. GFR was estimated using equations based on creatinine and cystatin C levels. Explanatory variables included body mass index (BMI), waist circumference (WC), and estimated visceral adipose tissue (eVAT). The mean age was 59.6 ± 9.2 years old and 75.9% were female. According to BMI, 28.2% of subjects were obese. Prevalence of increased WC and eVAT was 63.9% and 58.5%, respectively. Results from the assessment of GFR by BMI, WC, and eVAT categories showed that only women with increased eVAT (≥150 cm2) had a lower mean GFR by Larsson (P = 0.016), Levey 2 (P = 0.005), and Levey 3 (P = 0.008) equations. The same result was not observed when the MDRD equation was employed. No association was found between BMI, WC, eVAT, and GFR using only serum creatinine. In the early stages of CKD, increased eVAT in hypertensive women was associated with decreased GFR based on cystatin C.

Renal plasma flow and glomerular filtration rate duringacute kidney injury in man

During acute kidney injury (AKI), lowered glomerular filtration rate (GFR) is believed to be consequent to reduced renal plasma flow (RPF). We aimed to systematically evaluate the evidence for such an association. Using specific search terms, we systematically interrogated the Pub Med electronic reference database for studies of human AKI where renal plasma or blood flow and GFR were measured; older articles were then identified by screening bibliographies of retrieved reports. We identified 22 articles describing 250 patients (203 native kidney, 47 in renal allograft). Of these studies, 8 articles (110 patients) estimated effective renal plasma flow (ERPF) by clearance techniques and 14 articles (140 patients) estimated true renal plasma flow (TRPF). Mean RPF was 272 mL/min (95% CI 213–331) and GFR 13.9 mL/min (9.9–17.9). Mean TRPF was significantly greater than mean ERPF (344 vs. 180, p = 0.004) despite lower mean GFR (8.8 vs. 20.4, p = 0.002). There was no significant association between RPF and GFR between studies. Eleven studies presented individual patient data (76 patients: 49 TRPF, 27 ERPF); here, individual patient ERPF was associated with GFR (r2 = 0.52), but TRPF was not. During AKI in man, there is only a limited association between ERPF and GFR, and no detectable association between TRPF and GFR.

Antiretroviral therapy with tenofovir is associated with mild renal dysfunction

A cross-sectional study was conducted to compare patients treated with tenofovir with patients never treated with tenofovir. Patients on tenofovir showed a lower mean glomerular filtration rate estimated by creatinine clearance or cystatin C clearance compared with control patients. In total, 24 patients on tenofovir versus five control patients had proteinuria greater than 130 mg/day. In the majority of patients on tenofovir proteinuria was of tubular origin.

Lupus nephritis in childhood: a review of 53 patients followed at a single center.

We retrospectively evaluated the clinical and histopathological features, treatment modalities, and outcome of 53 children and adolescents with biopsy-proven lupus nephritis (LN), followed between September 1983 and September 2001. The mean age (+/-SD) at the time of diagnosis of systemic lupus erythematosus (SLE) was 12.9+/-2.6 years and the mean follow-up from the time of biopsy was 4.8+/-3.4 years. At the time of biopsy, all 53 patients had proteinuria, 21 (40%) had nephrotic syndrome, and 14 (26%) had impaired renal function. Class IV nephritis, observed in 34 (64%) patients, was the most frequent histopathology on initial renal biopsy. The patients with class IV LN had a significant tendency to develop hypertension ( P=0.04) and nephrotic syndrome ( P=0.027), and a lower mean glomerular filtration rate ( P=0.000). Based on the renal histopathology and clinical presentation, patients were treated with corticosteroids alone or combined with azathioprine or with intravenous cyclophosphamide. Plasmapheresis or cyclosporine was used in 4 and 1 patient, respectively. Follow-up biopsies, performed in 13 patients, showed no change in 6 patients, were progressive in 4, and regressive in 3. On final clinical evaluation, renal disease was in complete or partial remission in 42 of 53 patients (80%), 4 had clinically active disease but with normal renal function, and 7 (13%), all with WHO class IV LN, were classified as having an adverse outcome, i.e., either preterminal (2) or terminal (4) renal failure or death (1). Five-year kidney and patient survival rates from the time of biopsy to the endpoints of terminal renal failure or death were 88.6% and 98.1%, respectively, in the whole group, and 82.4% and 97.1%, respectively, in the WHO class IV group. Nephrotic syndrome and class IV nephritis at initial biopsy were the only parameters significantly associated with adverse outcome in our study group. There was no association with gender, age, hypertension, impaired renal function, anemia, increased morphological index scores, and treatment modalities. We conclude that clinical and histopathological features of LN and treatment regimens in our study do not differ markedly from those in most pediatric series. However, the 5-year kidney and patient survival rates are among the best reported in recent pediatric series. The prognosis of LN is primarily dependent on the histopathological lesions.

Influence of hydrocarbon exposure on the course of glomerulonephritis.

Seventy-one patients with nonsystemic, nonacute glomerulonephritis were included in a follow-up study on the influence of hydrocarbon exposure on the course of their disease. A possible exposure was ruled out by interview performed by occupational hygienists unaware of the outcome of the disease. The patients were allocated to three groups according to their hydrocarbon exposure. One group consisted of patients who had never been exposed; the second of patients who were exposed during follow-up and the third of patients who had discontinued their previous exposure. Each group was subdivided into one group with a glomerular filtration rate (GFR) that remained normal, and one group with a GFR that was, or became, subnormal. Patients with a subnormal GFR who discontinued their exposure had a more favorable course than those who continued to be exposed in spite of an initially lower mean GFR and an initially higher frequency of hypertension. No significant difference was seen between the groups with a normal GFR.