Symptoms Of Renal Failure Research Articles

Effectiveness of Multidisciplinary Post-Acute Kidney Injury Clinic on Awareness and Knowledge in Acute Kidney Injury Survivors

Introduction: Acute kidney injury (AKI) awareness and knowledge among survivors is poor, leading to suboptimal self-management and follow-up care. The purpose of the study was to evaluate the impact of a multidisciplinary post-AKI clinic on AKI awareness and knowledge among survivors. Methods: We conducted a quasi-experimental study among stage 2-3 AKI survivors who were followed in the multidisciplinary post-AKI clinic, comprising nephrologists, renal nurses, pharmacists, and dietitians. Patients were evaluated before and after entering the clinic during a 3-month follow-up period, using a three-component questionnaire including the following: (1) Do you know of your AKI diagnosis during hospitalization? (yes/no), (2) how do you rate your AKI knowledge? (ranging from 1 or “very low” to 5 or “excellent”), and (3) 25-item objective AKI knowledge survey instrument that covered general knowledge of AKI, nutrition, medication, and symptoms of renal failure. Results: A total of 108 AKI survivors were enrolled, with 37.0%, 41.7%, and 21.3% being stage 2 AKI, stage 3 AKI, and stage 3-dialysis AKI, respectively. Before entering the clinic, 50% of patients were unaware of their AKI during hospitalization. After receiving education from the multidisciplinary post-AKI clinic, all patients became aware they had experienced AKI. The mean perceived knowledge and objective knowledge scores were significantly increased over the 3-month period from 1.6 (0.7) to 3.9 (0.7) out of 5 and 15.4 (3.5) to 21.4 (2.0) out of 25, respectively (p < 0.001 for both). Additionally, reverse transformation of the Likert scale to a percentage format also revealed a significant improvement in mean perceived AKI knowledge scores, transitioning from 13.8 ± 16.8 to 73.0 ± 17.6, p < 0.001. Conclusion: The multidisciplinary post-AKI clinic effectively enhanced AKI awareness and knowledge among survivors. These findings highlight the importance of follow-up care and the benefits of a multidisciplinary approach. Further studies are needed to determine the long-term outcomes associated with increased knowledge.

Renal Failure, Types, Causes and Etiology: A Review Article

Renal failure is the most important disease that causes losing in the efficiency of kidney and is renal failure or may called end stage kidney disease where capacity for kidney become 15% less than the normal levels .This disease can be classified into two types : first (acute kidney failure ) which may resolve and it rapidly developed .Second (chronic kidney failure) : it slowly developed and may become a permanent condition Symptoms of Renal failure include vomiting; swelling in the legs; a loss of appetite; confusion and tiredness. Several complications occurred which include high blood potassium ; volume overload and uremia in acute condition while high blood pressure; anemia and heart disease in the chronic condition. There are several factors that may lead to the progress of acute renal failure conditions such as hypotension, a blockage of the urinary tract, hemolytic uremic syndrome and some medications.While diabetes ,hypertension, polycystic renal disease and nephrotic syndrome represent the major causes of chronic renal failure . Signs that help in identification of acute and chronic renal failure based on mishmash of several factors and help in distinguish between its types such as increasing of creatinine levels and decreasing of urine production are the signs of acute failure while decrease the rate of glomerular filtration to below of 15 or therapy with renal replacement are the signs of chronic renal failure. Acute failure can be treated depending on the main causes , on the other hand may use dialysis (hemodialysis or peritoneal dialysis) or kidney transplant in order treating chronic failure.

Secondary Hypertension Induced by Vitamin D3: A Case Report and Literature Review

Background: The effects of vitamin D on the skeletal system, biological metabolism, and immune system function are well shown. Cholecalciferol (vitamin D2) and ergocalciferol (vitamin) are 2 major types of vitamin D. Vitamin D3 deficiency is worldwide and the intoxication induced by it is very rare. Conclusion: Vitamin D3 is involved in calcium hemostasis. The effects of acute hypercalcemia on blood pressure were established. Hypercalcemia can elevate the blood pressure, and renal failure may predispose the individual to a hypertensive response. The clinical symptoms often associated with vitamin D3 intoxication are related to acute renal failure. Hypertension without acute renal failure symptoms can emphasize the relationship between acute hypercalcemia and hypertension.

Five Things to Know About Incremental Peritoneal Dialysis.

Incremental peritoneal dialysis (PD) offers patients newly starting dialysis less than the standard "full dose" of PD, reducing treatment burden and intrusiveness while minimizing symptoms of renal failure. Incremental PD is a cost-effective approach that has been associated with slower rates of decline in residual kidney function. This approach also produces less waste and in turn reduces environmental footprint compared to standard PD prescriptions. It also aligns with the International Society of Peritoneal Dialysis (ISPD) Practice Recommendations for high-quality, goal-oriented therapy. Awareness of incremental PD along with its advantages and limitations provides practitioners with the tools to provide more patient-centered dialysis prescriptions in appropriate populations.

CLINICAL AND MORPHOLOGICAL FEATURES OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION DIED OF SARS-COV-2 INFECTION

Objective: To assess clinical and pathomorphological features of kidney damage in patients with arterial hypertension (AH) who died of the new coronavirus infection COVID-19. Design and method: A complex analysis of 268 kidney autopsies was carried out, including the study of macro- and microscopic changes reflected in the protocols of pathological and anatomical autopsies and identified during the histological examination. In 224 patients (83.6%) with AH, the diagnosis was confirmed by isolating the SARS-CoV-2 RNA using the polymerase chain reaction; in 44 (16.4%) – through computed tomography of the lungs. The causes of deaths were the following: in 31 patients (11.6%) acute myocardial infarction; in 40 (14.9%) cerebrovascular accident; in 11 (4.1%) pulmonary embolism; 222 patients (83%) had acute respiratory distress syndrome. The analysis included 130 men aged 36 to 92 (72.6 years old on average) and 138 women aged 40 to 106 (77.1 years old on average). Results: In the kidneys we detected ischemic changes caused by disturbances in the microvasculature. These are stases, sludges, erythrocyte and fibrin thrombi predominantly in the medulla. In the glomeruli diapedesis hemorrhages, mesangial cells proliferation, basement membrane thickening and fibrinoid necrosis of the capillary wall were observed. In the epithelium of the convoluted tubules, a granular, hyaline-drop dystrophy and a necrosis as the extreme degree of the damage were noted. In the kidneys, a pronounced lymphoid and leukocyte infiltration was detected. These changes were accompanied by inflammation and renal failure symptoms. In particular, the level of C-reactive protein was 140.6 ± 7.42 mg/l; blood ferritin 1258.0 ± 110.1 mcg/l; blood leukocytes 15.0 ± 0.67 10^9/l; blood lymphocytes 1.54 ± 0.29 10^9/l; procalcitonin 1.350 ± 0.51 ng/ml. The development of hemorrhagic syndrome was observed in 93 (35%) cases. The level of D-dimer was 4326.4 ± 696.1 ng/ml; fibrinogen 18.2 ± 13.04 g/l; platelets 179.0 ± 8.7 10^9/l. Blood creatinine in patients aged 36 to 59 (27 people) was 120.6 ± 12.2 mmol/l; aged 60 to 80 (136 people) 136.6 ± 10.12 mmol/l; aged over 80 (105 people) 139.0 ± 11.7 mmol/l. Conclusions: The study of the kidneys in patients who died from the new coronavirus infection revealed microvasculature vessels damage and development of coagulation disorders amid the renal failure.

Multisystem inflammatory syndrome in children аssociated with COVID-19

Coronavirus disease is severe in the elderly and in people with chronic diseases such as diabetes mellitus, heart disease, chronic obstructive pulmonary disease, and cancers. It is generally accepted that in children, COVID-19 is much milder, and often is even asymptomatic. But there are some children who, against the background of the coronavirus infection, developed multisystem inflammatory syndrome (MIS-C). Its pathophysiology is not fully understood. There are several hypotheses about the mechanisms of MIS-C development. It is assumed that the syndrome develops due to an excessive immune response to the virus. Having some similar mechanisms with Kawasaki disease, macrophage activation syndrome, the development of MIS-C still has significant diffe-rences. Multiple organ damage occurs due to systemic inflammation, hypoxia, tissue ischemia. As a result, multiple organ dysfunction syndrome develops. Clinical manifestations are specific and reflect changes in all body systems. Laboratory studies revealed an increase in inflammatory markers, transaminases, creatinine, urea, coagulation disturbances. Treatment of multisystem inflammatory syndrome includes immunomodulatory and glucocorticoid therapies. Antibiotics, anticoagulants, antiplatelet agents are also administered, and in case of renal failure symptoms — dialysis replacement therapy. The article describes cases of successful treatment of children with multisystem inflammatory syndrome associated with COVID-19, which show that MIS-C can mask a large number of diseases. Attention should be paid to the need for hospitalization of such patients into a unit with the possibility of hemodialysis, to the different approaches to treatment, the importance of renal replacement therapy. If the above requirements are met, it is possible to achieve a complete recovery of patients.

Nursing Care in Postpartum Atypical Hemolytic Uremic Syndrome: A Case Report

Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is a systemic disease associated with high morbidity and mortality rates, caused by dysregulation of the alternative complement pathway, leading to uncontrolled complement activation resulting in thrombotic microangiopathy. In this case it’s reported patient care management of a P-aHUS patient which developed in postpartum period with renal failure, anasarca edema, hypertension and important laboratory signs of the syndrome. Patient was effectively treated by hemodialysis and eculizumab therapy, which controls complement activation and discharged without signs of hemolysis. The patient was discharged to home from the hospital after 42 days. At follow-up 2 weeks after discharge, all signs and symptoms of renal failure had resolved. The patient has not had any inpatient readmissions to the hospital to date. There are no case report in P-aHUS nursing care. Discussion of this case contributes the literature describing nursing interventions associated with caring for patients with P-aHUS.

The Influence of Dietary Interventions on Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).

Chronic kidney disease is a health problem whose prevalence is increasing worldwide. The kidney plays an important role in the metabolism of minerals and bone health and therefore, even at the early stages of CKD, disturbances in bone metabolism are observed. In the course of CKD, various bone turnover or mineralization disturbances can develop including adynamic hyperparathyroid, mixed renal bone disease, osteomalacia. The increased risk of fragility fractures is present at any age in these patients. Nutritional treatment of patients with advanced stages of CKD is aiming at prevention or correction of signs, symptoms of renal failure, avoidance of protein-energy wasting (PEW), delaying or prevention of the occurrence of mineral/bone disturbances, and delaying the start of dialysis. The results of studies suggest that progressive protein restriction is beneficial with the progression of renal insufficiency; however, other aspects of dietary management of CKD patients, including changes in sodium, phosphorus, and energy intake, as well as the source of protein and lipids (animal or plant origin) should also be considered carefully. Energy intake must cover patients’ energy requirement, in order to enable correct metabolic adaptation in the course of protein-restricted regimens and prevent negative nitrogen balance and protein-energy wasting.

Effectiveness of Intradialytic Stretching Exercises on Prevention and Reduction of Leg Muscle Cramps among Patients undergoing Hemodialysis: Randomized Controlled Trial

Renal replacement therapy is a treatment option for people who have acute or chronic renal failure. A patientwith increasing symptoms of renal failure is referred to a dialysis and transplantation center early in thecourse of progressive kidney disease. Hemodialysis is one of the most widely used dialysis procedures.Muscle cramps are the most common complication experienced by hemodialysis patients that usuallydevelop during and in between hemodialysis therapy. These cramps appear to be the most common reasonfor the early termination of the hemodialysis session. Study Design: Pretest-posttest non-blind randomizedcontrolled trial has been used in the present study to evaluate the effectiveness of Intradialytic stretchingexercises on the leg muscle cramps among patients undergoing hemodialysis, from the period of September5th, 2020 to March 22nd, 2021. Study Sample: Non-probability purposive Sample of 60 patients undergoinghemodialysis. The sample is divided randomly into two groups; 30 patients as the study group and theother 30 as the control group. The setting of the study: The study is conducted in Al-Najaf City/Al-NajafAl-Ashraf Health Directorate / Al-Sadder Medical City / The specialized center for kidney diseases andtransplantation / Hemodialysis Unit. Result: The study result signifies that the level of muscle crampsimproved significantly among the study group participants compared with control group.

NPHS2 gene polymorphism aggravates renal damage caused by focal segmental glomerulosclerosis with COL4A3 mutation.

Focal segmental glomerulosclerosis (FSGS), a type of primary glomerular disease, is the leading cause of end-stage renal disease (ESRD). Several studies have revealed that certain single-gene mutations are involved in the pathogenesis of FSGS; however, the main cause of FSGS has not been fully elucidated. Homozygous mutations in the glomerular basement membrane gene can lead to early renal failure, while heterozygous carriers develop renal failure symptoms late. Here, molecular genetic analysis of clinical information collected from clinical reports and medical records was performed. Results revealed that nephrosis 2 (NPHS2) gene polymorphism aggravated renal damage in three FSGS families with heterozygous COL4A3 mutation, leading to early renal failure in index patients. Our findings suggest that COL4A3 and NPHS2 may have a synergistic effect on renal injury caused by FSGS. Further analysis of the glomerular filtration barrier could help assess the cause of kidney damage. Moreover, a detailed analysis of the glomerular basement membrane-related genes and podocyte structural proteins may help us better understand FSGS pathogenesis and provide insights into the prognosis and treatment of hereditary glomerulonephropathy.

Aberrant gut microbiota alters host metabolome and impacts renal failure in humans and rodents

ObjectivePatients with renal failure suffer from symptoms caused by uraemic toxins, possibly of gut microbial origin, as deduced from studies in animals. The aim of the study is to characterise...

Computer-Aided Diagnosis and Clinical Trials of Cardiovascular Diseases Based on Artificial Intelligence Technologies for Risk-Early Warning Model.

The use of artificial intelligence in medicine is currently an issue of great interest, especially with regard to the diagnostic or predictive analysis of medical data. In order to achieve the regional medical and public health data analysis through artificial intelligence technologies, spark data analysis is adopted as the research platform for hypertension patients, and artificial intelligence technologies are used to preprocess the data with inconsistency, redundancy, incompleteness, noise and error; Aiming at the unbalanced data sets, the Z-score standard is adopted to convert data into usable form suitable for data mining. And, the application of Logistic, Naive Bayesian regression, and support vector machine based on three groups of different prognosis in severe cases, including stroke, heart failure and renal failure symptoms, establish the risk early warning model for 3years time. In addition, to select the optimal feature subset based on medicine big-data features, the model simplification and optimization are done in training process, the experimental results show that the feature subset selection can ensure the classification performance similar to the clinical features of the model. Therefore, according to chronic cardiovascular disease, acute cardiovascular events and cardiovascular events caused by critical illness events, we screen out the relevant prognosis of serious illness (stroke, heart failure, renal failure), which is related to the prognosis of serious illness. Targeted prevention has a guiding role and practical significance according to the results of artificial intelligence analysis.

Mitochondrial Activity and Skeletal Muscle Insulin Resistance in Kidney Disease

Insulin resistance is a key feature of the metabolic syndrome, a cluster of medical disorders that together increase the chance of developing type 2 diabetes and cardiovascular disease. In turn, type 2 diabetes may cause complications such as diabetic kidney disease (DKD). Obesity is a major risk factor for developing systemic insulin resistance, and skeletal muscle is the first tissue in susceptible individuals to lose its insulin responsiveness. Interestingly, lean individuals are not immune to insulin resistance either. Non-obese, non-diabetic subjects with chronic kidney disease (CKD), for example, exhibit insulin resistance at the very onset of CKD, even before clinical symptoms of renal failure are clear. This uraemic insulin resistance contributes to the muscle weakness and muscle wasting that many CKD patients face, especially during the later stages of the disease. Bioenergetic failure has been associated with the loss of skeletal muscle insulin sensitivity in obesity and uraemia, as well as in the development of kidney disease and its sarcopenic complications. In this mini review, we evaluate how mitochondrial activity of different renal cell types changes during DKD progression, and discuss the controversial role of oxidative stress and mitochondrial reactive oxygen species in DKD. We also compare the involvement of skeletal muscle mitochondria in uraemic and obesity-related muscle insulin resistance.

Early response as shown by enhancement of transglutaminase 1 expression after cisplatin-induced acute kidney injury

Acute kidney injury (AKI) is caused by drugs and other stimuli, which limits the use of several therapeutic approaches. The AKI mouse model generated by intraperitoneal administration with cisplatin, one of the most widely used anti-cancer drugs, is generally applied to study on this disease. Transglutaminases are posttranslational modifying enzymes that catalyze irreversible cross-linking reactions between proteins in several biological events such as skin formation and blood coagulation. In this study, we found an increase in the expression level of transglutaminase (TG1) in the kidney of mice which had been injected with cisplatin and underwent progressive nephrotoxicity. Before the appearance of the tentative symptoms of renal failure, which is apparent by morphological damage in the kidney and increases in blood creatinine levels, both the expression level and activity of TG1 rapidly increased mainly at the proximal tubule. On the other hand, the protein expression level of another major isozyme (TG2) remained mostly unaltered. This investigation will provide a possible basal-level biomarker and also information on progression of renal failure from the aspect of the protein-modifying enzyme, transglutaminase.

Evaluation of zoonotic potency of Escherichia coli O157:H7 through arbitrarily primed PCR methods

ObjectiveTo evaluate the zoonotic potency of Escherichia coli O157:H7 through arbitrarily primed-PCR (AP-PCR) methods as one of the DNA fingerprinting methods. MethodsA total of 14 isolates consisted of 11 isolates originated from human feces with renal failure symptoms, 2 isolates originated from cattle feces, and 1 control isolate were used in this study. DNA of each isolate was extracted, and their profiles were studied by using AP-PCR method with M13 F and M13 R arbitrary primers. ResultsThe results founded that all of 14 isolates had similarity range from 54.6% to 88.5%. Isolates KL-106(3) and KL-55(6) originated from humans showed the degree of similarity with isolates SM-25(1) and SM-7(1) originated from cattle as high as 85% and 77%, respectively. ConclusionsThe high degree of similarity between isolates originated from cattle and human indicated the high potency of zoonoses. The results also concluded AP-PCR method as a briefly fingerprinting method in order to trace the epidemiological of E. coli O157:H7.

Japanese society for dialysis therapy clinical guideline for "hemodialysis initiation for maintenance hemodialysis".

Yuzo Watanabe, Kunihiro Yamagata, Shinichi Nishi, Hideki Hirakata, Norio Hanafusa, Chie Saito, Motoshi Hattori, Noritomo Itami, Yasuhiro Komatsu, Yoshindo Kawaguchi, Kazuhiko Tsuruya, Yoshiharu Tsubakihara, Kazuyuki Suzuki, Ken Sakai, Hideki Kawanishi, Daijo Inaguma, Hiroyasu Yamamoto, Yoshiaki Takemoto, Noriko Mori, Kazuyoshi Okada, Hiroshi Hataya, Takashi Akiba, Kunitoshi Iseki, Tadashi Tomo, Ikuto Masakane, Tadao Akizawa, and Jun Minakuchi, for “Hemodialysis Initiation for Maintenance Hemodialysis” Guideline Working Group, Japanese Society for Dialysis Therapy

Immunoglobulin G4-related Retroperitoneal Fibrosis: A New Name for an Old Disease

lthough retroperitoneal fibrosis (RF) was first described by the French urologist Albarran in A1905,1 it is the American Urologist John Kelso Ormond (1886-1978) who is credited with the first detailed description of the disease in the English literature in 1948. He described 2 patients with diffuse fibrosis of the retroperitoneal tissues. His description of the clinical and pathological features of idiopathic retroperitoneal fibrosis established the condition as a clinical entity. The idiopathic or primary type occurs in patients aged 40-60 years with a male:female ratio of 2-3:1, and in over 70% of cases the cause is unknown. The fibrosis may extend into the thoracic cavity and pelvis. Initially, the patient presents with nonspecific symptoms (eg, loss of appetite, weight loss, and low-grade fever). Dull, noncolicky pain in the lower back, loin, or abdomen has been reported in up to 90% of cases. The pain may respond to nonsteroidal anti-inflammatory drugs. The pain is not affected by movement and, early in the disease, there are hardly any urinary symptoms. In later stages, the presentation of RF is characterized by progressive ureteric obstruction (usually bilateral) with loin pain, which may be colicky in nature. If not diagnosed, symptoms of renal failure and uremia prevail. Urine examination is often normal in early stages. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) are raised even during the early stages of the disease. Anemia may occur and, in the early stages, is because of the acute inflammatory phase but in advanced cases, it is because of the uremia. Antinuclear antibodies are positive in 60% of cases. Imaging usually demonstrates that the retroperitoneal involvement is typically not entirely diffuse, presenting primarily as inflammatory masses that often predominantly involves the kidneys, the ureters, which are usually medially displaced, or the abdominal aorta. Ureteric obstruction with hydronephrosis is a common associated finding.

A giant inguinoscrotal bladder hernia as a cause of chronic renal failure: A rare case

INTRODUCTIONGiant inguinoscrotal bladder hernias are very rare and require surgical intervention. They usually do not cause any specific symptoms and thus, they are often misdiagnosed. If left untreated though, they might lead to severe medical conditions, such as renal failure. PRESENTATION OF CASEWe present the case of a 71-year-old male patient suffering from a giant inguinoscrotal mass, accompanied by symptoms of the lower urinary track (LUTS) and chronic renal failure. DISCUSSIONIn our case, the patient presented with bladder hernia causing non specific symptoms of renal failure. In contrast to acute renal failure, a chronic renal impairment most often comes with no specific symptoms and thus, it can be present for many years before the diagnosis is made. It is evident that such serious conditions should be suspected and treated. CONCLUSIONInguinoscrotal bladder hernias may be associated with severe medical conditions, such as renal deterioration, and should be considered in the differential diagnosis of renal failure, when accompanied by any inguinal, scrotal, or low abdominal wall hernia.

Concurrent and Fatal HHV-8 Positive Multicentric Castlemanʼs Disease and Kaposiʼs Sarcoma in a HIV Negative Kidney Transplant Recipient

Castleman's disease is a rare lymphoid disorder. It comprises two pathological entities. These are the hyaline-vascular type, which is usually localized (uni-centeric), and the plasma cell type which is usually multicenteric and rather aggressive. Castleman's disease has been described thrice after kidney transplantation. A 62-year-old Caucasian male with a history of kidney transplant presented high fever, night sweats, dyspnoea, coughing, weakness, hepatosplenomegaly, peripheral lymphadenopathy and symptoms of renal failure within 6 years of the transplantation. Laboratory findings revealed anaemia (haemoglobin = 4.6 mmol/l), thrombocytopenia (101 × 109/L), normal WBC total and differential count, renal function impairment (creatinine = 218 μmol/l), hypoalbuminemia (24 g/l), and elevated CRP (133 mg/l). Diagnostic assays for HIV-1 were performed with repeatedly negative results. No acute CMV or EBV infection was detected (by serology and PCR analysis). The clinical diagnosis at this stage was post-transplant lymphoproliferative disorder, therefore dosage of cyclosporin immunosuppression was decreased. CT-scans revealed hepatosplenomegaly and enlarged abdominal lymph nodes. A bone marrow biopsy showed an active haematopoiesis in all cell lineages without any abnormalities. Histological examination of an axillary lymph node biopsy showed a multifocal proliferation of spindle cells. The diagnosis of Kaposi's sarcoma was confirmed by positive staining of these spindle cells with antibodies against factor VIII-related antigen (not shown) and HHV-8. The remainder of the lymph node showed partly involuted germinal centres, surrounded by small lymphocytes. A number of these lymphocytes also stained positive for HHV-8, as seen in multicentric Castleman's disease. The clinical syndrome and the histological findings were compatible with KS and MCD caused by HHV-8 infection in a long-term immunocompromised patient. HHV-8 DNA load in serum or plasma was determined by real-time quantitative PCR (15 × 105 copies/ml). His condition deteriorated rapidly and he died despite therapy. The unicentric Castelman's disease, histopathologically described as the hyaline-vascular subtype, is more common, it is not associated with HHV8-infection, and can mostly be treated effectively with radiotherapy or surgery. The multicentric form is not well understood: it is an atypical lymphoproliferative disorder of a plasma cell type, and is related to immune dysfunction. Patients with MCD often develop malignancies like Kaposi's sarcoma and non-Hodgkin's lymphoma. Clinically, HHV8-positive MCD is more aggressive, and has a poorer prognosis with a median survival of less than 30 months. MCD, whether or not HHV8-associated, is generally treated with combination chemotherapy and steroids.

Cistatina C sérica: uma alternativa prática para avaliação de função renal?

Glomerular filtration rate is the main marker of renal function in healthy individuals and patients. Despite incontestable advances in medicine, it is still difficult to define precisely this test in clinical practice. Early markers of renal lesion are important, because glomerular filtration rate usually decreases before the first chronic renal failure symptoms or signs appear. Cystatin C has been pointed as an alternative, but it was not tested in many diseases. Advantages and disadvantages of this marker are discussed. Although serum cystatin C determination is increasingly being used in clinical practice worldwide, its limitations as well as the conditions its use is in fact indicated are not adequately established; on the other hand serum creatinine (and creatinine clearance) is an easily available and low cost laboratory marker with well-known limitations that can be used routinely in the assessment of renal function.