Stages Of Chronic Renal Disease Research Articles

Homocysteine as a predictive biomarker in early diagnosis of renal failure susceptibility and prognostic diagnosis for end stages renal disease

Glomerular filtration rate and/or creatinine are not accurate methods for renal failure prediction. This study tested homocysteine (Hcy) as a predictive and prognostic marker for end stage renal disease (ESRD). In total, 176 subjects were recruited and divided into: healthy normal group (108 subjects); mild-to-moderate impaired renal function group (21 patients); severe impaired renal function group (7 patients); and chronic renal failure group (40 patients) who were on regular hemodialysis. Blood samples were collected, and serum was separated for analysis of total Hcy, creatinine, high sensitive C-reactive protein (CRP), serum albumin, and calcium. Data showed that Hcy level was significantly increased from normal-to-mild impairment then significantly decreases from mild impairment until the patient reaches severe impairment while showing significant elevation in the last stage of chronic renal disease. Creatinine level was increased in all stages of kidney impairment in comparison with control. CRP level was showing significant elevation in the last stage. A significant decrease in both albumin and calcium was occurred in all stages of renal impairment. We conclude Hcy in combination with CRP, creatinine, albumin, and calcium can be used as a prognostic marker for ESRD and an early diagnostic marker for the risk of renal failure.

Relationship between ultrasonographically determined kidney volume and progression of chronic kidney disease.

Aim To investigate a correlation between calculated creatinine clearance as a measure of kidney's functional abilities and ultrasonographically determined kidney volume, which represents actual size of the kidney, in fact residual renal mass in chronic kidney disease, in order to determine possibilities of ultrasound as a diagnostic method in diagnosing and follow up of chronic renal disease. Methods Prospective study included 150 patients with registered demographic and anthropometric data, and also with relevant laboratory tests of renal function. Longitudinal diameter, thickness and width of the kidney and renal volume calculated according to the Dinkel's formula were measured by ultrasound. A correlation between the measured volume of the kidneys and calculated creatinine clearance was done by the Spearman method, with statistical significance of p<0.05. Results Statistically significant correlation between the estimated creatinine clearance values and the average of the calculated values of kidney volume was found (p<0.01). Average value of the kidneys' volume showed a linear decrease with the progression of chronic kidney disease: the kidney volume in the control healthy group was 171.7 ± 32.6 mL (95.22- 229.59 mL), and in the subjects classified in stage IV it was 74.7 ± 24.6 mL (43.22-165.65 mL). Conclusion Calculated volume of kidney well correlated with creatinine clearance as a measure of functional ability of the kidneys and with the stage of chronic renal disease. It can be used in clinical practice for monitoring of chronic kidney disease in conjunction with other clinical and laboratory parameters.

Prevalence of Pulmonary Hypertension in Patients with Early Stages of Chronic Renal Disease

Aim : Pulmonary hypertension (PHT) was recently described as a cardiovascular complication of chronic kidney disease (CKD). There are many studies on the prevalence of PHT in patients undergoing hemodialysis (HD); however, there are no data on the presence or prevalence of PHT in patients with early-stage kidney disease. Materials and Methods : The demographic and laboratory findings for 172 adult patients with stage 1-5 CKD, as well as Doppler echocardiographic findings were evaluated. Systolic pulmonary arterial pressure (sPAP) was compared according to CKD stage, and also between the patients in stages 1-4 and those in stage 5 with and without AVF. Results : Mean age of the patients was 55.4 ± 15.2 years. Mean sPAP in the entire study group was 34.5 ± 5.7 mmHg and PHT was noted in 90 (52.3 %) patients. Mean sPAP and the prevalence of PHT were similar in the stage 1-4 patients and stage 5 patients, regardless of HD (P=0.86). The serum calcium level was significantly lower and the serum intact parathyroid hormone level was significantly higher in patients with PHT than in those without PHT (P = 0.02, and P = 0.03). Conclusion: The present findings show that the prevalence of PHT in patients with early stage CKD was similar to those with stage 5 CKD. Due to the high morbidity and mortality rates associated with PHT, follow-up of sPAP via Doppler echocardiography might be indicated in all patients with CKD.

ASSESSMENT OF PULMONARY HYPERTENSION BY ECHOCARDIOGRAPHY IN PATIENTS WITH PREDIALYSIS STAGE OF CHRONIC KIDNEY DISEASE

Investigation data presented revealed association between pulmonary hypertension and the stage of chronic renal disease. It was shown that development of pulmonary hypertension was noted at the earliest stages of the chronic renal disease (when glomerular filtration rate decreased to < 80 ml/min) and the rate of hypertension development increased with the progression of the disease.

Strengths of primary healthcare regarding care provided for chronic kidney disease.

ABSTRACTObjective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. Results: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). Conclusion: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. Conclusion: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

Chronic Kidney Disease and Lipid Disorders.

Introduction:Chronic kidney disease (CKD) represents a serious public health problem due to the increase in incidence and prevalence of this disease worldwide. Given the significant morbidity and mortality from cardiovascular disease (CVD) in the population of patients with CKD, and the fact that dyslipidemia itself is a risk factor for CVD, increases the importance of lipid metabolism study in patients with CKD. Goal: Evaluate the lipid status of patients with chronic kidney disease.Material and methods:A one-year prospective study included 150 adult patients who were in various stages of chronic renal failure (stage I to IV). Estimate of creatinine clearance was performed using Cockroft-Goult formula. The classification of patients according to stages of chronic renal insufficiency was performed in accordance with the criteria of Kidney Disease Outcomes Quality Initiative (K/DOQI).Results:Of the total number of patients (N=150) there was 71 males and 79 females. The mean age of patients was 55.43 years. Average values of serum cholesterol were highest in patients with stage II renal disease and the lowest in patients classified as stage IV (5.76±1.60 mmol/L vs. 5.07±1.88 mmol/L). Analysis of the average value of triglycerides in blood show a slight increase through the stages of CKD in a manner that patients classified into stage I have low serum triglyceride levels (1.73±1.17 mmol/L (range 0.61 to 5.5 mmol/L), and patients classified in stage III the highest value 2.13±1.11 mmol/L (range 0.62 to 4.66 mmol/L).Conclusion:Average cholesterol levels does not statistically significantly change with progression of chronic renal disease. There is an almost linear increase in average triglyceride levels in chronic renal disease. Triglyceride levels in serum begins to increase in the early stage of chronic renal disease and reach the peak in stage IV.

Intra-hepatic Atherosclerosis Disease: An Incidental Finding in Acute Abdominal Pain Patient

Introduction: A 69 year-old female was incidentally diagnosed to have an intra-hepatic atherosclerosis disease on 3D Reconstruction of Abdominal Computed Tomography Angiography performed at the Emergency Room, while surgeons and urologist were evaluating an acute abdominal pain in a patient with several comorbidities. The radiological findings and differential diagnosed are briefly discussed. For academic, research and publication purposes, the patient signed an informed consent Keywords: Abdominal pain; Atherosclerosis disease; Intrahepatic; Vascular biology. Clinical Scenario/Question: A previously well-known 69 year-old female with a large medical history of Systemic Lupus Erythematous (SLE), Lupus Nephritis (LN), Hypertension (High Blood Pressure), Hypothyroidism, Antiphospholipid Syndrome (APS) Chronic renal disease stage III B, episode of extensive Deep Vein Thrombosis (DVT) in the right lower limb andPulmonary Embolism (PE), an episode of Multiple Organ Failure (MOF), that required Renal Replacement Therapy (RRT), was brought to the emergency room consulting for a suddenly acute abdominal pain focused in the right lumbar region and right flank, intensity 8/10 in the Visual Analog Scale (VAS), associated with nauseas, vomiting. Abdominal CT scan and CT urography were performed by general surgeon recommendation. Abdominal CT scan images showed a hypodense, homogeneous, well- demarcated lesion of 42 × 38 mm, without the presence of enhancement, nearly the bifurcation of the right common iliac artery, which implies adnexal origin. No free abdominal fluid was observed and no intra-abdominal collections were considered (Figure 1). CT urography reported right hydroureteronephrosis, hepatic residual calcifications and pelvic cystic lesion with no relevant anatomical impact in this area. Secondary to the wide range of findings and unclear principal diagnosis, a 3D Reconstruction of Abdominal Computed Tomography Angiography was ordered, incidentally diagnosed to have an intra-hepatic atherosclerosis (Figure 2). What is the possible diagnosis? 1. Intra-hhepatic atherosclerosis 2. Hematogenous metastasis 3. Giant cell arteritis 4. Hemangiomas 5. Polyarteritis nodosa The atherosclerosis disease is a common disorder in general population characterized by the present of endothelial damage, secondary to the deposition in plaques of fatty material on their inner walls, silently and slowly blocking the lumen of the arteries, putting the blood flows at risk. This medical situation may finally develop ischemic and embolic event [1,2]. This pathophysiologic disorder may be affected or exacerbated by other comorbidities in some patients such as exogenous and endogenous factors. The atherosclerosis disease is commonly found in vessels of great or middle caliber, most of them illustrated to have a rich laminar blood flow, which allow the development of atherosclerotic plaques [3,4]. In this medical case, the patient presented an important autoimmune background; including SLE, APS, a prothrombotic predisposition, calcium, lipids and inflammation factors deposits, that may lead a deleterious role in the genesis of atherosclerosis in minor vessels that are not expected to be affected. Finally, the blood flow compromised in these vessels can be reflected in lesions of important organs such as kidneys, brain, heart and splanchnic bed [5,6,7]. In conclusion, Intra-Hepatic Atherosclerosis Disease discovered at the emergency room in the clinical scenario of the acute abdominal pain, has to be considered by clinicians and emergency physicians as differential diagnosis.

Creatinine or cystatin C – which is a better index of renal function in morbid obesity?

The most important index of renal function is estimated glomerular filtration rate (eGFR) which can be calculated from creatinine or cystatin C concentration in serum. There is uncertainty, which formula is best suited to assess renal function in morbidly obese patients. The aim of this study was to evaluate eGFR in patients with morbid obesity using formulas: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Grubb, Le Bricon, Hoek, Larsson, and to compare the obtained results. In 40 morbidly obese patients, serum concentration of cystatin C and creatinine were assayed. Values of eGFR were calculated using the above-mentioned formulas. The mean value of eGFR ranged from 85.9 to 111.1 ml/min/1.73 m², depending on the formula. The biggest difference between the obtained values was 29% (Grubb vs. Hoek p<0.01). After calculation of eGFR from creatinine concentration (MDRD), 7 patients were qualified to the 2nd and 3rd stage of chronic renal disease, while application of Hoek's formula, based on cystatin C concentration, allotted 27 patients to 2nd and 3rd stage of chronic renal disease. Le Bricon formula gave eGFR values, that correlated best with albuminuria. eGFR calculated using Le Bricon formula based on the cystatin C concentration was significantly lower than eGFR calculated from creatinine concentration and was more closely associated with albuminuria. Relying only on creatinine concentration to estimate glomerular filtration rate can lead to underestimation of renal malfunction in obese patients.

P-022 Renal Disease Associated with Crohnʼs Disease, Mesalamine and Infliximab

15 year old female with 5 year history of Crohn's Disease (CD) ileocolitis developed increasing serum creatinine concentrations over a 6 month period. She was steroid and mesalamine (50 mg/kg/day) dependant for 1 year after diagnosis of CD prompting addition of Remicade therapy at 5 mg/kg/dose every 8 weeks. Relapsing disease continued and dose of Remiade was increased to 10 mg/kg every 8 weeks 2 years post diagnosis. Interval of administration was gradually shortened to every 4 weeks by 3 years post diagnosis. Symptoms stabilized on this regimen. However, ESR increased to 50–60 for the 6 months period (4.5–5 yrs post CD diagnosis) prior to renal disease recognition. No urinary tract symptoms noted, Creatinine 1.22 mg/dL, Creatinine Clearance 53 mL/min/1.73 m2, ANA 1:320. No other serum immune abnormalities detected. Renal Biopsy revealed active chronic tubulointerstitial nephritis, mesangioproliferative immune complex glomerulopathy with focal global glomerulosclerosis. Discontinuation of Remicade and mesalamine led to rapid decrease in ESR to 11, and gradual decrease over the next year in serum creatinine to range of 0.99–1.07 mg/dL and rise in creatinine clearance to 68 mL/min/1.73 m2 which although improved continues to be compatible with quiescent chronic renal disease stage 2. Biweekly Humira 40 mg/dose was initiated 3 months after discontinuing pentasa and Remicade. Differential diagnoses of renal disease incriminate: CD, mesalamine, infliximab or autoimmune disease and or combination of these processes. Clinical History recounted above. Clinical History recounted above. Included in abstract.

The role of mineral and bone metabolism disorders in the development and progression of cardiac and renal pathology in the patients presenting with long-lasting type 1 diabetes mellitus

The present study included a total of 96 patients with long-lasting type 1 diabetes mellitus (DM1) and early (0-5) stages of chronic renal disease (CRD). Replacement renal therapy (RRT) consisted of programmed hemodialysis (PHD) and kidney transplantation (KT). Routine clinical examination was supplemented by the assessment of phosphorous and calcium metabolism indices, measurement of cardiac pathology markers, and studies of coronary artery calcification with the use of multispiral computed tomography (MSCT) of the heart with the calculation of the Agatston score index. It was shown that the impairment of the renal function was accompanied by a rise in the phosphorus, parathormone, and FGF-23 levels, increased vitamin D deficiency (with a slight deviation of its levels from the reference values in the patients at high risk of cardiovascular events treated with PHD). In the patients who had undergone KT and showed fairly good function of the renal transplant, the above parameters were similar to those of the patients with stage 0-4 CRD which suggested their normalization in case of adequate RRT during DM1. The progress of cardiovascular pathology with the deterioration of the renal function was manifested as an increase of NT-proBNP levels in parallel to the duration of CRD (r=0.304; p&lt;0.05), decrease of the glomerular filtration rate (p=-0.540; p&lt;0.05), and their significant correlation with the main characteristics of mineral homeostasis. The degree of coronary artery calcification was related to the patients' age, duration of DM1, and severity of arterial hypertension. The high Agatston score index and pronounced left ventricular hypertrophy in the patients following KT are supposed to reflect the irreversible character of certain cardiovascular lesions persisting despite optimal RRT and positive dynamics of phosphorus and calcium metabolism and NT-proBNP levels. It is concluded that the development and progression of renal dysfunction are associated with the disturbances of mineral and bone metabolism that promote further progress of cardiovascular pathology that is the main cause of mortality among this cohort of patients.

THU0393 Estimated Glomerular Filtration Rate is Associated with Bone Fragility in the Elderly

BackgroundOsteoporosis is frequently associated with renal disease, namely the bone metabolism disturbances caused by chronic kidney disease (CKD). Both diseases are highly prevalent in the elderly. The increased risk of...

The use of dipeptidyl peptidase-4 inhibitors for the treatment of patients with type 2 diabetes mellitus and chronic renal disease

The rapid increase in the number of patients with type 2 diabetes mellitus and renal pathology necessitates the revision of the presently adopted approaches to renal replacement therapy with a view of relieving the economic and financial burden imposed by the use of expensive therapeutic methods on the health budgets of the developed countries. The importance of achievement and maintenance of the target blood sugar levels for the prevention of the development and progression of renal lesions has been demonstrated in a series of large-scale clinical studies. Compensation of disorders of carbohydrate metabolism at the late stages of chronic renal disease in the patients presenting with diabetes mellitus encounters difficulties arising from the danger of hypoglycemia associated with the impairment of renal gluconeogenesis, cumulation of antiglycemic agents and their metabolites, decreased clinical significance of glycated hemoglobin levels under conditions of developing anemia and marked hyperglycemia. Discontentedness with the currently available means for the control of carbohydrate metabolism that fail to meet the up-to-date-requirements for the effectiveness and safety in a given clinical situation accounts for the ever increasing interest in the possibility of using innovative incretin-based medicines taking into account their pharmacological profile (they are known to change insulin secretion in response to variations in blood glucose levels, improve the function of beta-cells, have beneficial effect on the cardiovascular system, and control body weight).

Comparison of seven estimated glomerular filtration rate equations in kidney patients

The degree of glomerular filtration rate determines the stages of chronic renal disease and, therefore, knowledge on its estimation is essential. Two standardized creatinine based estimated glomerular filtration rate equations and five equations based on the immunoturbidimetric determination of cystatin C were compared. The distribution of the analytes and the equations, their relations, as well as the differences among the estimated glomerular filtration rates and their chronic kidney disease stages assignments were studied. The equations based on cystatin C classified more patient into stage 1, while the creatinine based ones more into stages 2, 3 and 4. The equations published as Grubb1, Grubb2 and Larsson classified more patients while the equations created by Tan and Sjöström classified fewer into stage 5 compared to the creatinine based equations. The equations of Grubb1 and Grubb2 resulted in the most similar stage assignment. The occurrence of stages between 3 and 5 was the lowest using the equation of Sjöström. The different equations for the estimation of glomerular filtration rate modify significantly the chronic kidney disease stage assignment which may have an influence on the treatment and outcome measures of the patients.

A High Red Blood Cell Distribution Width Predicts Failure of Arteriovenous Fistula

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p<0.001), monocyte number (HR 0.02; 95% CI 0.00 to 0.21; p = 0.001), and red blood cell distribution width (RDW) (HR 1.44; 95% CI 1.17 to 1.78; p<0.001). RDW was the only significant factor in receiver operating characteristic curve analysis (area under the curve 0.644; CI 0.51 to 0.76; p = 0.046). RDW>16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure.

A high red blood cell distribution width predicts failure of arteriovenous fistula

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p 16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure.

Effects of Carvedilol as Third-Line Add-On Therapy on Blood Pressure and Glucose Metabolism in Type 2 Diabetic Patients with Chronic Renal Disease Stage 3 and Above

Background: We evaluated the effect of coadministration of β-blocker (carvedilol) as the third agent with angiotensin II receptor blockers (ARB) and calcium channel blockers (CCB) on blood pressure (BP) regulation and glucose metabolism. Methods: Diabetic patients who did not achieve the therapeutic BP goal (140/90 mmHg) by ARB and CCB combination therapy were recruited. This study was designed to compare the BP regulating effects by adding carvedilol (10 mg/day, n=30) and by doubling the dose of either ARB (n=34) or CCB (n=31). Serum glucose metabolism was examined. Results: The carvedilol group showed a decrease (P<0.01) in BP from 166±11/90±8 to 156±9/84±7 mmHg at 12 weeks. In the ARB and CCB groups, BP also decreased (P<0.01) from 164±11/87±8 to 153±10/83±8 and 163±7/87±8 to 153±8/84±9 mmHg at 12 weeks. The rates of achieving therapeutic goal at 12 weeks were 36.7% in the carvedilol, 38.2% in the ARB and 41.9% in the CCB group. Serum glucose metabolism did not change in all groups. Conclusions: These results suggest that adding carvedilol decreased BP as safely as increasing the dose of ARB or CCB in patients with diabetic nephropathy.

Différents stades de l’insuffisance rénale chronique : recommandations

Summary The ANAES has defined four stages of chronic renal disease according to the presence of markers of kidney damage and to Cockcroft clearance (an estimate of endogeneous creatinine clearance). Renal insufficiency is defined by a Cockcroft clearance below 60 ml/min per 1.73 m2. Renal insufficiency is moderate if Cockcroft clearance is between 59 and 30 ml/min, severe between 29 and 15 ml/min, and end stage below 15 ml/min. Recommendations for the management of patients are given at each stage. The National Kidney Fundation has defined five stages of chronic kidney disease introducing mild renal insufficiency if estimated glomerular filtration rate is between 89 and 60 ml/min.

Insuficiência renal oculta acarreta risco elevado de mortalidade após cirurgia de revascularização miocárdica

Preoperative chronic renal dysfunction is an independent predictor of mortality in cardiac surgery. As normal range serum creatinine is not representative of normal renal function, we compared mortality rates, total hospital stay and post-surgical hospital stay for patients who underwent isolated coronary artery bypass surgery with serum creatinine < 1.5mg/dL as to their estimated creatinine clearance, normal or impaired. In 4,765 patients submitted to coronary artery bypass surgery between January/1996 and June/2004, the creatinine clearance was estimated by the Cockroft-Gault equation. Impaired renal function was considered as a creatinine clearance <60 mL/min/1.73 m² (chronic renal disease stage 3 - National Kidney Foundation-USA). In hospital mortality, total hospital stay, and post-surgical hospital stay were compared. 4,688 patients had the required data, and 4,403 presented serum creatinine < 1.5 mg/dL - 3,177 with creatinine clearance > 60 mL/min (Group A), and 1,226 with <60 mL/min (Group B). Group B patients had significantly higher total hospital stay and post-surgical hospital stay than those in Group A (respectively 2.85 and 1.79 more days--P < 0.0001). Relative risk of in-hospital death was 2.09 to Group B (95%CI:1.54-2.84) when compared to Group A. More than one quarter of the patients with serum creatinine <1.5 mg/dL had creatinine clearance <60 mL/min. This expressive number of patients, that would not have their renal dysfunction detected by the serum creatinine parameter alone, had double the risk of death, longer total hospital stay and post-surgical hospital stay than the other patients with serum creatinine < 1.5mg/dL.

Risk factors for development of cardiovascular complications in patients with chronic renal disease and diabetic nephropathy.

Cardiovascular diseases are the most frequent causes of morbidity and mortality in patients with chronic renal disease. The aim of our paper is to evaluate the risk factors of cardiovascular complications in patients with various stages of chronic renal disease (CRD), with or without diabetes mellitus (DM). The study included 98 patients with different stages of the CRD, with creatinine clearance <60 ml/min/1.73m2, and laboratory parameters monitored: homocysteine, BNP, cholesterol, LDL, HDL, HbA1c, Body Mass Index (BMI). First group comprised 49 patients with DM, age 50-82 years, M 28/F 21. Second group comprised 49 patients without DM, age 35-80 years, M 18/F 31. The IMT (intima media thickness) was measured by B-mode ultrasonography, and all patients had echocardiography examination done by 2D Doppler ultrasonography. The IMT values in diabetic patients had statistically significant positive correlation with homocysteine values of r=0.9393, p<0.034, and cholesterol r=0.289, p<0.05, compared to non-diabetics. A significant negative correlation was found between the ejection fraction (EF) and BMI in both groups, more prominent in non-diabetics r=0.289, p<0.044 (diabetics r=0.162, p>0.05). 47.4% of diabetics had arteriosclerotic changes on carotid arteries, 8.5% had stenosis of ACC, and 22.0% had rhythm abnormalities on ECG. A positive correlation between IMT and BMI was found in diabetics, but was not statistically significant r=0.111, p>0.05. In the diabetics group a significantly higher (p<0.05) values of BNP, HbA1c, proteinuria, BMI, and cholesterol were found, and significantly lowered EF (p<0.0001). Risk factors for cardiovascular complications in patients with DM are various, and the most pronounced significance was found in the values of homocysteine, BNP and cholesterol.

Relation Between Total Renal Volume and Renal Function: Usefulness of 3D Sonographic Measurements With a Matrix Array Transducer

The aims of this study were to evaluate the reproducibility of 3D sonography with a matrix array transducer as a means of measuring renal volume and to investigate correlations between renal volume and renal function. One hundred twenty subjects (20 consecutively registered patients with one of the five stages of chronic renal disease and 20 healthy volunteers [stage 0 renal function]) were enrolled. Individual renal volume was determined by two independent observers using 2D sonographic and 3D matrix array transducer sonographic data. The reproducibility of volume measurement was evaluated for both of these methods. After total renal volume was normalized to body surface area, correlations between normalized total renal volume and estimated glomerular filtration rate (GFR) were evaluated. Differences in normalized total renal volume related to stage of renal function also were evaluated. The reproducibility of 3D sonographic measurements obtained with a matrix array transducer was greater than that of 2D sonographic measurements. The correlation between normalized total renal volume obtained with matrix array transducer 3D sonography and estimated GFR for two observers (r = 0.809 and 0.813; p < 0.001) was better than that between normalized total renal volume obtained with 2D sonography and estimated GFR (r = 0.696 and 0.715; p < 0.001). The mean normalized total renal volumes obtained with matrix array transducer 3D sonography in stages 0 and 1 were significantly larger than those in other stages (p < 0.001). The mean normalized total renal volume in stage 5 disease was significantly smaller than the volumes in the other stages (p < 0.001). Three-dimensional sonography with a matrix array transducer is a reliable means of measuring renal volume during evaluations of patients with reduced renal function.