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1
Nair, Sunil. "Variability in creatinine and estimated glomerular filtration rate in diabetic nephropathy." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3005923/.
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Introduction: Diabetic nephropathy is a leading cause of end stage renal disease (ESRD) in the world. Accurate screening and staging of chronic kidney disease (CKD) is essential for timely intervention as recommended by national and international guidelines (KDOQI, 2007, RCP, 2006) and to guide dose adjustment of several medicines. Glomerular filtration rate (GFR) is recognised as the best measure of kidney function in health and disease, but measuring it by gold standard techniques such as inulin clearance, and radio-isotopic methods is clinically impractical. Therefore estimation of GFR using serum creatinine and other variables like age, gender race and body size is recommended (Levey, 2003, Levey, 2006). The most widely used formula to estimate GFR is the 4-variable MDRD equation. Aims & Methods: My thesis contains studies of variation in serum creatinine, estimated glomerular filtration rate and urinary albumin creatinine ratio. There are two main experimental studies and three further studies based on data analyses and validation. 1. Effect of obesity on eGFR in type 2 diabetes: The aim was to estimate the bias between isotopic glomerular filtration rate (GFR) and eGFR in patients with Type 2 diabetes with chronic kidney disease and relate it to their body mass indices (BMI). GFR was measured using 51Cr EDTA method and was estimated by 4v-MDRD eGFR using IDMS calibrated creatinine in 111 participants. 2. The performance of CKD-EPI formula compared to the MDRD equation in estimating GFR in participants with type 2 diabetes associated CKD: The aim was to use our dataset to compare the effect of obesity on eGFR calculated by the CKD-EPI formula (Levey and Stevens) and by the 4-variable MDRD equation. 3. Derivation of obesity correction equation for 4-variable MDRD: To derive a 'correction factor' for the 4-variable MDRD equation to adjust for the equation's underestimation of true (isotopic) GFR in obese subjects with Type2 diabetes. Linear and non-linear regression analyses were performed to derive equations which reduced the bias between estimated and measured GFR. 4. Effect of cooked meat protein on eGFR estimation in type 2 Diabetes related chronic kidney disease: To estimate the biological variation in creatinine levels caused by a standardised cooked meat meal in subjects with diabetes mellitus and various stages of chronic kidney disease, compared to healthy volunteers. 64 participants in chronic kidney disease stages 1-4 and 16 healthy volunteers were fed cooked meat and non-meat protein meals to study the effect of cooked meat protein on creatinine and eGFR. 5. Effect of cooked meat protein on urinary albumin creatinine ratio in patients with type2 Diabetes related chronic kidney disease: To determine the effect of a cooked meat meal on UACR in diabetic patients with diabetes related chronic kidney disease. 80 participants had their urinary albumin creatinine ratio calculated before and 4 hours after a cooked meat meal. Results & Conclusions: 1. The 4-v MDRD formula underestimates GFR in overweight and obese patients with Type 2 diabetes. The bias between estimated and measured GFR in the obese type 2 diabetic subjects persists across the range of CKD stages. This may have Implications for management of obese patients with Type 2 diabetes, where treatment options for the management of hyperglycaemia, hypertension and other concomitant conditions are often determined by the eGFR. 2. The bias between estimated and measured GFR significantly worsens when eGFR was calculated using the CKD-Epi compared to the 4 variable MDRD formulas in patients with type2 diabetes and chronic kidney disease. There remains a need for better-validated equations to estimate GFR in the obese patients with diabetes. 3. The linear and non-linear equations derived from our study reduce the bias significantly in the external dataset; this improvement being more pronounced in the obese subjects and is best achieved by the ratio model equation which scores consistently well across all three ranges of GFR studied, including a very good positive predictive value in CKD stage 3 in the obese. This simple corrective factor if externally validated can be used when making management decisions in the obese with type2 diabetes based on eGFR. 4. Consumption of a standardised cooked meat meal significantly increased serum creatinine and resulted in significant fall in eGFR in all stages of CKD studied; 6 of 16 CKD 3a patients were misclassified as CKD 3b. This effect of cooked meat on serum creatinine disappears after 12 hours of fasting in all study participants. Creatine in meat is converted to creatinine on cooking. This is absorbed causing significant increase in serum creatinine levels and a consequent drop in eGFR. This could impact management as threshold for commencing and withdrawing certain medications and decisions regarding investigations is defined by eGFR. An eGFR calculated using fasting serum creatinine would be a better reflection of kidney function in these patients. 5. Urine albumin to creatinine ratio falls after a cooked meat meal in patients with diabetes associated chronic kidney disease. This fall in ACR increases with worsening stages of chronic kidney disease. Cooked meat consumption is a major factor leading to variation in ACR values, which should be considered when interpreting results.
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Baines, Laura Anne. "Effect of three years antihypertensive therapy on renal structure in type 1 diabetic patients with albuminuria : the European Study for the Prevention of Renal Disease in Type 1 Diabetes (ESPRIT)." Thesis, University of Newcastle upon Tyne, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289203.
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Zappitelli, Michele. "Derivation and validation of prediction equations for glomerular filtration rate in children." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=98527.
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Current prediction equations for glomerular filtration rate (GFR), the most important measure of renal function, are neither accurate nor precise in children. Clinical data were abstracted from 207 charts of pediatric patients with renal disease attending the Montreal Children's Hospital from 1999-2004, to derive serum creatinine (SCR)-based equations and test their ability to predict iothalamate clearance, a gold standard measure of GFR, using linear regression and the Bayesian Information Criterion. In a separate study, CysC-based equations were derived from data on cystatin C (CysC) previously measured in 103 children between 1999 and 2003. Two SCR equations were derived for patients with or without spina bifida. Mean biases were -0.97 ml/min/1.73m 2 and +1.2 ml/min/1.73m2, respectively. Precision, 95% limits of agreement, and sensitivity for detecting abnormal renal function were superior for the new formulae compared to previously published equations. Two CysC-based equations were derived with or without the inclusion of SCR, which were less biased and more precise than comparison formulae and more sensitive but less specific for detecting GFR < 90 ml/min/1.73m 2. Future studies should evaluate the equations derived here, in different populations of children.
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Wilson, Katherine E. "Evaluation of iohexol clearance to estimate glomerular filtration rate in normal horses." Thesis, Virginia Tech, 2006. http://hdl.handle.net/10919/31970.
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In adult horses and foals, renal dysfunction can occur as a secondary complication to gastrointestinal disorders, dehydration, septicemia, endotoxemia and nephrotoxic drug administration. Measurement of renal function is an important feature not only in the diagnosis, but also in the prognosis and management of renal disease. Commonly used drugs such as phenylbutazone and gentamicin can be highly nephrotoxic under certain conditions.
Estimation of the glomerular filtration rate (GFR), accepted as one of the earliest and most sensitive assessments of renal function, can be determined in horses using standard techniques such as endogenous or exogenous renal creatinine clearance. These techniques can be time consuming, dangerous to perform on fractious patients, require trained personnel and are subject to errors most often associated with improper or incomplete urine collection. Recently, tests using iohexol, a radiographic contrast agent, have been developed to estimate the GFR in human beings, pigs, sheep, dogs, cats and horse foals with results that have been validated by traditional standards.
Serum clearance of a substance that is freely filtered by the kidneys without tubular secretion or reabsorption, that is not protein bound, and that is not metabolized, is a measurement of glomerular filtration rate. Iohexol meets all of these requirements and thus its clearance from serum should accurately estimate GFR. Utilization of serum clearance studies for estimation of GFR provides a clinically feasible and reproducible method in order to measure GFR in horses. Other commonly used methods to assess renal function in horses are fraught with inherent and operator error. Serum clearance of iohexol does not necessitate collection of urine and has been shown to be a safe, reproducible method using collection of timed blood samples to assess renal function in humans and animals. The objectives of this project were 1) to determine a method of estimation of GFR based on serum clearance of a substance that meets the requirements of a marker for GFR, and 2) to make the method clinically applicable by developing a method using two blood samples to derive clearance and thus GFR in normal adult horses.
Results of this study showed good agreement between GFR derived by exogenous creatinine clearance and serum clearance of iohexol. In addition, GFR values for all horses using either method were within published reference ranges for this species. The results of this study indicate that a single intravenous injection of iohexol at a dose of 150 mg/kg, followed by collection of 2 serum samples at 3 and 4 hours post injection can be used to estimate the GFR in healthy horses.<br>Master of Science
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Gonda, Kathleen A. "Evaluation of Iohexol Clearance to Estimate Glomerular Filtration Rate in Normal Horse Foals." Thesis, Virginia Tech, 2002. http://hdl.handle.net/10919/31934.
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Estimation of the glomerular filtration rate (GFR), accepted as one of the earliest and most sensitive indicators of renal dysfunction, can be determined in horses using standard techniques
In adult horses and foals, renal dysfunction can occur as a secondary complication to gastrointestinal disorders, dehydration, septicemia, endotoxemia and nephrotoxic drug administration. Measurement of renal function is an important feature not only in the diagnosis, but also in the prognosis and management of renal disease. Commonly used drugs such as phenylbutazone and gentamicin can be highly nephrotoxic under certain conditions. Of particular concern are those drugs, including the aminoglycoside antibiotics, that are eliminated almost exclusively by the kidney. Knowledge of a patients renal status prior to treatment would direct efforts at; 1) restoring kidney function prior to protracted therapy with potentially damaging drugs, 2) adjusting the dose of a life-saving drug based on the magnitude of dysfunction, or 3) selecting a drug that is not dependant on renal function for elimination. such as endogenous or exogenous renal creatinine clearance. Unfortunately, these techniques can be time consuming, dangerous to perform on fractious patients, require trained personnel and are subject to errors most often associated with improper or incomplete urine collection. Recently, tests using iohexol, a radiographic contrast agent, have been developed to estimate the GFR in human beings, dogs and cats with results that have been validated by traditional standards. Most testing protocols require a single bolus injection of iohexol, followed by 2 or 3 blood samples obtained over a few hours. Compared to traditional testing methods, samples are easily and rapidly obtained making the testing procedure less stressful for the patient. A simple method to measure GFR in horses that does not require urine collection, would allow veterinarians in a clinical setting the ability to determine a patientâ s renal status easily and safely.
The objectives of this study were; 1) model the pharmacokinetic profile of iohexol in horse foals, 2) compare creatinine clearance, an accepted standard for GFR determination in patients, with iohexol clearance, and 3) develop sampling parameters and calculation methods for a practical test, based on iohexol clearance, that compares favorably with creatinine clearance in horse foals.
Iohexol concentration time data were best described using a 3-compartment open model. Mean creatinine clearance (2.17 ml/min/kg) and mean iohexol clearance (2.15 ml/min/kg) showed good agreement. In addition, GFR values for all foals using either method were within published reference ranges for this species. The results of this study indicate that a single intravenous injection of iohexol at a dose of 150 mg/kg, followed by collection of 2 serum samples at 4 and 6 hours post injection can be used to estimate the GFR in healthy horse foals. Mean corrected GFR value (CLpredicted) for 10 foals in this study was 2.15 ml/min/kg.<br>Master of Science
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Kampa, Naruepon. "Renal scintigraphy in dogs : evaluation of glomerular filtration rate measurement by 99mTc-DTPA renogram /." Uppsala : Dept. of Biomedical Sciences and Public Health, Swedish University of Agricultural Sciences, 2006. http://epsilon.slu.se/200609.pdf.
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Chernyukh, O. G. "Estimation of the renal condition by glomerular filtration rate in the pregnant with preeclampsy." Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18363.
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Bird, Nicholas James. "Use of the terminal rate constant in the assessment of glomerular filtration rate by clearance of injected tracers." Thesis, University of Surrey, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436077.
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Kemperman, Frits Anton Willem. "Improvements in the use of plasma creatinine as a marker of the glomerular filtration rate." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2001. http://dare.uva.nl/document/59881.
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Coulthard, Malcolm George. "Renal function in preterm babies." Thesis, University of Newcastle Upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340669.
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Johnston, Nicklett Johnston. "The Effect of Health Literacy in Low Estimated Glomerular Filtration and Diabetes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3895.
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Health literacy is widespread, but its potential is not recognized. By not recognizing health literacy, patients have the burden of coping with diabetes with renal complications without full knowledge of their responsibility to their health. The focus of the project was to assess participants with diabetes with low health literacy and low mean glomerular filtration rate (eGFR). The project goal was achieved by the assessment of the participants' health literacy and eGFR before and after education for their diabetes, then assessed to determine if teaching the participants would improve their health literacy, lab values, and overall health. Participants were recruited by being patients of the designated clinic and screened for diabetes and low eGFR, for a total of 30 participants. The Brief Health Literacy Screen was used to measure health literacy. The health of the participants was appraised by the laboratory values of eGFR and fasting glucose. The project methodology was an observational design using correlation and 2-sample t analysis with the variables eGFR, fasting glucose, and health literacy. The variables were compared before and after the participants' education. Results showed health literacy with patient education was associated with greater patient self-efficacy and improved fasting glucose numbers, eGFR flows, and health literacy scores. The current health climate shows value in different types of health providers. Social change was defined by the project launching a nurse practitioner as the leader for advancing the treatment plans of chronic kidney disease. This project impacts social change by showing patients in the process of improved health and empowering the patients to be advocates of their own health.
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Almond, Gregory Thomas Hudson Judith A. "Depth-corrected versus non depth-corrected GFR determination by quantitative renal scintigraphy in the dog." Auburn, Ala, 2009. http://hdl.handle.net/10415/1653.
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Almeida, Gilsirene Scantelbury de [UNESP]. "Comparação entre as diferentes formas de avaliar a taxa da Filtração Glomerular na população idosa atendida no Centro de Atenção Integrada de Melhor Idade – CAIMI na cidade de Manaus." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/108403.
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000733099.pdf: 472916 bytes, checksum: 1c725a43faa2e29a92740f18a4a9cef2 (MD5)<br>A doença renal crônica (DRC) representa um problema de saúde pública global. Os idosos têm diminuição progressiva da função renal e os hipertensos e diabéticos apresentam maior risco de lesão renal. Essas doenças crônicas são comuns aos idosos favorecendo o comprometimento de lesão renal. Com base neste fato, o objetivo do estudo foi identificar o melhor método para avaliar precocemente a filtração glomerular (FG) em indivíduos idosos. Comparando-se as fórmulas baseadas na creatinina sérica, bem como o Clearance de Creatinina de 24h com a fórmula baseada nos níveis séricos de Cistatina C, eleita como padrão ouro. Foi realizado um estudo observacional, analítico, de delineamento transversal sobre a filtração glomerular e o desenvolvimento da doença renal, com base nos resultados obtidos na avaliação clínica e nos exames laboratoriais de bioquímica e urinálise. Participaram do estudo 180 idosos de ambos os sexos, com idade igual ou superior a 60 anos, do Centro de Atenção Integrada da Melhor Idade (CAIMI), da cidade de Manaus-AM. Foram construídos gráficos de dispersão, calculado o coeficiente de correlação, bem como traçados diagramas de Bland Altman e curvas ROC. A média de idade dos 180 idosos foi de 67 anos - 68,8% do sexo feminino, e 31,1% do sexo masculino. Hipertensos representaram 43,5% do total. Renais crônicos representaram 19%. Portadores de diabetes mellitus chegaram a 38,3%. Ao observar a equação de regressão, quando o CKD-epiCys for zero, o Clearance de Creatinina (ClCr) valerá 62,07 ml/min/1,73m2, o que caracteriza uma superestimação do valor real da FG. A média avaliada pelo ClCr e CKD-epiCys foi de 28,8 ml/min/1,73m2. Este valor é bem superior à zero, que seria o ideal. Isto mostra que o ClCr superestima a FG avaliada pelo CKD-epiCys. A curva ROC para o ClCr na discriminação da presença de FG< 60 ml/min avaliada pelo padrão foi de 0,65, com ...<br>Chronic kidney disease (CKD) is a global public health problem. The elderly have progressive decrease of renal function, and those with hypertension and diabetes are at increased risk of kidney damage. These chronic diseases are common to the elderly and promote renal injury. This study aimed to identify the best method to assess early glomerular filtration (GF) in elderly subjects. Formulas based on serum creatinine and creatinine clearance of 24 hours were compared with the formula based on serum cystatin C chosen as gold standard. We conducted an observational, analytical, cross-sectional design of the glomerular filtration rate and the development of kidney disease, through results obtained in clinical evaluation, and biochemistry and urinalysis laboratory tests. Participants were 180 patients of both sexes, aged over 60 years, from the Centro de Atenção Integrada da Melhor Idade [Center for Integrated Management of the Elderly], in the city of Manaus, State of Amazonas, Brazil. Scatter plots were constructed by calculating the correlation coefficient, as well as Bland Altman plotted diagrams and ROC curves. The average age of the elderly participants was 67 years; 68.8% were female and 31.1% male; 43.5% had hypertension; 19%, chronic renal failure; and 38.83%, diabetes mellitus. By observing the regression equation, when the CKD-epiCys was zero, creatinine clearance (CrCl) was 62.07 ml/min/1.73m2, which means overestimation of the real FG rate. The average assessed by CrCl. and CKD-epiCys was 28.8 ml/min/1,73m2, a value above zero, which would be ideal. This shows that CrCl. overestimates FR assessed by CKD-epiCys. The ROC curve for CrCl to discriminate the presence of FG <60 ml / min measured by the standard was 0.65, with 95% confidence interval from 0.56 to 0.76 (p = 0.006). The CrCl had statistically significant predictive power concerning the presence of KD. The regression was assessed by ...
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Almeida, Gilsirene Scantelbury de. "Comparação entre as diferentes formas de avaliar a taxa da Filtração Glomerular na população idosa atendida no Centro de Atenção Integrada de Melhor Idade - CAIMI na cidade de Manaus /." Botucatu, 2013. http://hdl.handle.net/11449/108403.
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Orientador: Roberto Jorge da S. Franco<br>Coorientador: Luis Cuadrado Martin<br>Banca: Pasqual Barretti<br>Banca: Vanessa dos Santos Silva<br>Banca: Eduardo Barbosa Coelho<br>Banca: Marcio Dantas<br>Resumo: A doença renal crônica (DRC) representa um problema de saúde pública global. Os idosos têm diminuição progressiva da função renal e os hipertensos e diabéticos apresentam maior risco de lesão renal. Essas doenças crônicas são comuns aos idosos favorecendo o comprometimento de lesão renal. Com base neste fato, o objetivo do estudo foi identificar o melhor método para avaliar precocemente a filtração glomerular (FG) em indivíduos idosos. Comparando-se as fórmulas baseadas na creatinina sérica, bem como o Clearance de Creatinina de 24h com a fórmula baseada nos níveis séricos de Cistatina C, eleita como padrão ouro. Foi realizado um estudo observacional, analítico, de delineamento transversal sobre a filtração glomerular e o desenvolvimento da doença renal, com base nos resultados obtidos na avaliação clínica e nos exames laboratoriais de bioquímica e urinálise. Participaram do estudo 180 idosos de ambos os sexos, com idade igual ou superior a 60 anos, do Centro de Atenção Integrada da Melhor Idade (CAIMI), da cidade de Manaus-AM. Foram construídos gráficos de dispersão, calculado o coeficiente de correlação, bem como traçados diagramas de Bland Altman e curvas ROC. A média de idade dos 180 idosos foi de 67 anos - 68,8% do sexo feminino, e 31,1% do sexo masculino. Hipertensos representaram 43,5% do total. Renais crônicos representaram 19%. Portadores de diabetes mellitus chegaram a 38,3%. Ao observar a equação de regressão, quando o CKD-epiCys for zero, o Clearance de Creatinina (ClCr) valerá 62,07 ml/min/1,73m2, o que caracteriza uma superestimação do valor real da FG. A média avaliada pelo ClCr e CKD-epiCys foi de 28,8 ml/min/1,73m2. Este valor é bem superior à zero, que seria o ideal. Isto mostra que o ClCr superestima a FG avaliada pelo CKD-epiCys. A curva ROC para o ClCr na discriminação da presença de FG< 60 ml/min avaliada pelo padrão foi de 0,65, com ...<br>Abstract: Chronic kidney disease (CKD) is a global public health problem. The elderly have progressive decrease of renal function, and those with hypertension and diabetes are at increased risk of kidney damage. These chronic diseases are common to the elderly and promote renal injury. This study aimed to identify the best method to assess early glomerular filtration (GF) in elderly subjects. Formulas based on serum creatinine and creatinine clearance of 24 hours were compared with the formula based on serum cystatin C chosen as gold standard. We conducted an observational, analytical, cross-sectional design of the glomerular filtration rate and the development of kidney disease, through results obtained in clinical evaluation, and biochemistry and urinalysis laboratory tests. Participants were 180 patients of both sexes, aged over 60 years, from the Centro de Atenção Integrada da Melhor Idade [Center for Integrated Management of the Elderly], in the city of Manaus, State of Amazonas, Brazil. Scatter plots were constructed by calculating the correlation coefficient, as well as Bland Altman plotted diagrams and ROC curves. The average age of the elderly participants was 67 years; 68.8% were female and 31.1% male; 43.5% had hypertension; 19%, chronic renal failure; and 38.83%, diabetes mellitus. By observing the regression equation, when the CKD-epiCys was zero, creatinine clearance (CrCl) was 62.07 ml/min/1.73m2, which means overestimation of the real FG rate. The average assessed by CrCl. and CKD-epiCys was 28.8 ml/min/1,73m2, a value above zero, which would be ideal. This shows that CrCl. overestimates FR assessed by CKD-epiCys. The ROC curve for CrCl to discriminate the presence of FG <60 ml / min measured by the standard was 0.65, with 95% confidence interval from 0.56 to 0.76 (p = 0.006). The CrCl had statistically significant predictive power concerning the presence of KD. The regression was assessed by ...<br>Doutor
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Gref, Margareta. "Glomerular filtration rate in adults : a single sample plasma clearance method based on the mean sojurn time." Licentiate thesis, Umeå universitet, Klinisk fysiologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-42319.
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Glomerular filtration rate (GFR) is a key parameter in evaluating kidney function. After a bolus injection of an exogenous GFR marker in plasma an accurate determination of GFR can be made by measuring the marker concentration in plasma during the excretion. Simplified methods have been developed to reduce the number of plasma samples needed and yet still maintain a high accuracy in the GFR determination. Groth previously developed a single sample GFR method based on the mean sojourn time of a GFR marker in its distribution volume. This method applied in adults using the marker 99m Tc-DTPA is recommended for use when GFR is estimated to be ≥ 30 mL/min. The aim of the present study was to further develop the single plasma sample GFR method by Groth including patients with severely reduced renal function and different GFR markers. Three different GFR markers 51Cr-EDTA, 99mTc-DTPA and iohexol were investigated. Formulas were derived for the markers 51Cr-EDTA and iohexol when GFR is estimated to be ≥ 30 mL/min. For patients with an estimated GFR < 30 mL/min a special low clearance formula with a single sample obtained about 24 h after marker injection was developed. The low clearance formula was proven valid for use with all three markers. The sources of errors and their influence on the calculated single sample clearance were investigated. The estimated distribution volume is the major source of error but its influence can be reduced by choosing a suitable sampling time. The optimal time depends on the level of GFR; the lower GFR the later the single sample should be obtained. For practical purpose a 270 min sample is recommended when estimated GFR ≥ 30 mL/min and a 24 h sample when estimated GFR < 30 mL/min. Sampling at 180 min after marker injection may be considered if GFR is estimated to be essentially normal.
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Akbari, Ayub. "Change in Referral Patterns to Nephrologists after Estimated Glomerular Filtration Rate (eGFR) Reporting: An interrupted time series analysis." Thesis, University of Ottawa (Canada), 2011. http://hdl.handle.net/10393/28785.
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Objectives: To update a Cochrane review of interventions to improve outpatient referral and to assess changes in referrals to nephrologists after initiating automatic estimated glomerular filtration rate (eGFR) reporting.
Methods: Systematic review using standardized Cochrane methods. Before and after study with interrupted time series analysis using data from retrospective chart review on referrals from family medicine to nephrology.
Results: Review added one new study and removed one for total of 17 studies. Referrals improved with education and structured referral sheets. Of 2766 eligible referrals for one-year pre-eGFR reporting to one-year post, 96.6% were reviewed. There was a 68.2% increase in referrals for chronic kidney disease (P < 0.01) and a 64.1% increase in total appropriate referrals (P =0.01) with no significant change in proportion of appropriate referrals (-2.5%, P=0.56).
Conclusion: Systematic review findings did not change from the previous review. eGFR reporting increased both appropriate and inappropriate referrals.
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Sydorchuk, L. P. "Glomerular filtration rate and lipids' metabolism disorders in hypertensive patients depending on aldosterone synthase gene CYP11B2 (-344C/T) polymorphism." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18560.
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Zimmerman-Pope, Nancy. "Effect of Fenoldopam on Renal Function in Normal Dogs Following Nephrotomy." Thesis, Virginia Tech, 2003. http://hdl.handle.net/10919/31732.
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Objective: To evaluate the effect of fenoldopam on renal function in normal dogs subjected to bisection nephrotomy. In addition, effects of bisection nephrotomy on renal function in normal dogs were evaluated. <p>
Study Design: Controlled, randomized, blinded experiment <p>
Sample Population: Sixteen mixed breed adult dogs
<p>Methods: Dogs were paired for sex, body weight, and approximate age and were assigned to one of two groups: fenoldopam (F) or placebo (P). Baseline glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), urinalysis (UA), and urine culture were performed prior to surgery. A left bisection nephrotomy was performed via a standard midline celiotomy. Dogs in Group F received perioperative intravenous infusion of fenoldopam (0.1 ìg/kg/min) for 90 minutes; dogs in Group P received 0.9 % saline (equivalent volume/kg) for 90 minutes. Body temperature, heart rate, respiration, direct arterial blood pressure, and urine volume were recorded during anesthesia. Renal function was assessed by measuring SCr, BUN, and GFR based on quantitative renal scintigraphy using 99mTc-DTPA at 1, 21, and 42 days after surgery.<p>
Results: There was no significant difference between groups in physiologic parameters assessed. There was no significant difference in GFR, BUN, or SCr between groups or between operated or control kidneys.<p>
Conclusions: Bisection nephrotomy in normal dogs with renal arterial occlusion of 15 minutes and a simple continuous capsular closure does not adversely affect renal function. <p>
Clinical Relevance: Further study investigating perioperative effects of fenoldopam in dogs with existing renal dysfunction is indicated. Bisection nephrotomy, as described in this study, does not decrease renal function as measured by BUN, SCr, or GFR.<br>Master of Science
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Martucci, Alexandre Fabrício. "Achados hemodinâmicos e de função e toxicidade renais após a infusão de carreadores de oxigênio baseados em hemoglobina." Botucatu, 2016. http://hdl.handle.net/11449/144382.
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Orientador: Yara Marcondes Machado Castiglia<br>Coorientador: Paulo do Nascimento Junior<br>Resumo: As reações adversas relacionadas à transfusão sanguínea chegam a 0,138%. Lesão Pulmonar Aguda Relacionada à Transfusão (TRALI), imunossupressão, febre, transmissão de patógenos e reação hemolítica aguda são as complicações mais comuns. Na tentativa de mitigar essas reações, pesquisadores tentam criar carreadores de oxigênio eficazes e não tóxicos. As soluções até agora apresentadas não foram melhores do que uma transfusão sanguínea. O óxido nítrico (NO) tem influência nas alterações vasculares e pode ter influência na toxicidade. Assim como o NO, a curva de saturação da hemoglobina (Hb) pelo oxigênio e a meia-vida são características que não foram completamente investigadas quanto à toxicidade e às alterações sistêmicas e micro-hemodinâmicas. Objetivo. Determinar se as diferentes propriedades quanto à meia-vida, à dissociação de oxigênio e à cinética de NO de soluções de carreadores de oxigênio baseados em Hb (HBOC) afetam a microvasculatura e a função renal, diferentemente. Material e Métodos. Estudo prospectivo realizado no Laboratório de Bioengenharia da Universidade da Califórnia, San Diego, EUA, usando hamsters Sírios Dourados machos. Foi injetado um HBOC em animal previamente anestesiado e operado para instalação de uma janela de visualização da microvasculatura e, também, para implante de cateteres centrais. Cinco tipos de solução que variavam entre elas quanto à meia-vida, à curva de dissociação do oxigênio e ao consumo de NO foram empregadas. Foram ... (Resumo completo, clicar acesso eletrônico abaixo)<br>Doutor
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Mafham, Marion. "Assessing associations between measures of reduced glomerular filtration rate, abnormal cardiovascular risk factors, and risk of cardiovascular morbidity and mortality." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29245.
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This thesis considers the hypothesis that small reductions in glomerular filtration rate (GFR), across the population range, are associated with a clustering of cardiovascular risk factors and increased risk of cardiovascular disease and death. The performance of a new method of assessing GFR, in which total plasma iohexol clearance is measured using dried capillary blood spots, was examined in a cross-sectional study of 81 consecutive individuals undergoing routine measurement of GFR. The new blood spot iohexol clearance (BSIC) method (using 3 blood spot samples) assessed GFR accurately compared to traditional iohexol clearance using 3 timed plasma samples; while prediction equations to estimate GFR from blood creatinine and cystatin c concentration performed poorly. Among 106 participants with measurements of BSIC-GFR, and GFR estimated from blood creatinine and cystatin c concentration, one or more measures of GFR were positively correlated with blood high density lipoprotein cholesterol concentration, and were inversely correlated with blood concentrations of triglyceride, C-reactive protein, fibrinogen, and homocysteine. BSIC-GFR was not more strongly related to cardiovascular risk factors than GFR estimated from blood creatinine concentration (eGFR). Cystatin c based GFR was strongly related to measures of body fat, while no relationship was seen with the other GFR measures. In a meta-analysis of cohort studies assessing the relationship between eGFR and risk of death and cardiovascular events, which included 4 061 003 and 1 372 820 individuals for each outcome respectively, a 30% lower eGFR was associated with a 20-30% increase in risk of both outcomes, depending on the type of study examined. however, there was significant heterogeneity between the studies. Large scale studies in which GFR is accurately measured are needed. Using the new BSIC method for this purpose is potentially feasible, but further work is required to ensure accuracy when the blood sampling is completed by participants themselves.
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Medeiros, Flávia Silva Reis. "Avaliação da dosagem sérica de cistatina C para detecção precoce de alterações na função do enxerto após o transplante renal." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5148/tde-04042008-152959/.
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INTRODUÇÃO: A cistatina C é uma proteína não glicosilada de baixo peso molecular que é produzida por todas as células nucleadas. A medida da concentração sérica (CS) de cistatina C tem sido aclamada como um marcador de função renal superior à medida da CS de creatinina. No presente estudo, avaliou-se a acurácia diagnóstica da proteína cistatina C em estimar mudanças no Ritmo de Filtração Glomerular (RFG) medido por 51Cr-EDTA, em análise longitudinal prospectiva de pacientes transplantados renais com tempo de transplante recente e tardio. Em uma fase inicial (Fase A), definimos a melhor estratégia metodológica para a realização do RFG por depuração plasmática de 51Cr-EDTA em receptores de enxerto renal utilizando a depuração renal de inulina como método padrão-ouro. MÉTODOS: Medidas simultâneas de depuração renal de inulina e de depuração plasmática de 51Cr-EDTA foram feitas em pacientes transplantados renais. A precisão do método de medida do RFG por 51Cr-EDTA foi avaliada em doadores após um ano de doação de rim. A análise de Bland&Altman foi empregada para avaliar a concordância entre os métodos. Em uma segunda fase, foram realizadas medidas das CS de cistatina C e de creatinina e do RFG por 51Cr-EDTA nos meses 1, 3, 6 e 12 de seguimento clínico do estudo em pacientes transplantados renais. A cistatina C foi dosada em amostras de soro, por técnica de imunonefelometria (N Latex Cystatin C kit - Dade Behring). A tendência da função renal foi obtida por Regressão Linear Simples. RESULTADOS: Na fase A, foram incluídos 44 pacientes transplantados renais e 22 doadores de rim com tempo de doação de 12,4 a 53,5 meses. A depuração de 51Cr-EDTA com amostras de sangue coletadas nos tempos 2, 4, 6 e 8 horas após injeção do radiofármaco apresentou forte correlação e alto grau de concordância com a depuração de inulina; uma estratégia única para todos os níveis de função foi estabelecida com amostras de sangue nos tempos 4 e 6 horas. Em uma segunda fase do estudo, oitenta e dois pacientes foram incluídos, com idade média de 43,4 ± 11,9 anos. A maioria era da raça branca (56%) e do sexo masculino (68%). No mês 1, a média do RFG por 51Cr-EDTA foi de 50,6 ± 17,3 ml/min/1,73m², e foi de 1,62 ± 0,65 mg/L para a CS de cistatina C e de 1,40 ± 0,62 mg/dL para a CS de creatinina. Na análise transversal, foi encontrada uma forte correlação entre o RFG e a medida de CS de cistatina C. Entretanto, na análise longitudinal do seguimento clínico a CS de cistatina C não estimou a tendência de mudança no RFG. CONCLUSÕES: A depuração plasmática de 51Cr-EDTA é uma medida precisa e acurada de RFG que pode ser utilizada em substituição à depuração renal de inulina, em pacientes transplantados renais. Medidas seriadas da CS de cistatina C não foram capazes de detectar mudanças no RFG em pacientes transplantados renais.<br>INTRODUCTION: Cystatin C is a nonglycosylated protein that is synthesized by all nucleated cells. The present study aimed to analyze the accuracy of serum concentration of cystatin C for detecting longitudinal change in glomerular filtration rate in transplanted recipients, as well to define a better methodological strategy to perform the plasma clearance of 51Cr-EDTA in renal transplant patients using inulin clearance as the gold standard method. METHODS: in the first phase of the study, simultaneous measurements of plasma clearance of 51Cr-EDTA and renal clearance of inulin in stable renal transplanted patients were performed. The within-subject repeatability of the 51Cr-EDTA was evaluated in live kidney donors at least 12 months after donation. Bland&Altman statistical approach was used to quantify the degree of agreement between clearance of inulin and plasma clearance of 51Cr-EDTA. In a second phase, serial measures of plasma clearance of 51Cr-EDTA, serum cystatin C and serum creatinine were examined in folowing at 1, 3, 6 and 12 months in kidney transplanted patients. Serum cystatin C was measured by a nephelometric immunoassay (N latex cystatin C kit - Dade Behring). The trend in renal function over time was obtained by linear regression. RESULTS: In the first phase, 44 transplanted patients and 22 kidney donors at least 12 months after donation (range 12,4 to 53,5 months) were enrolled. Plasma clearance of 51Cr-EDTA with four samples taken at 2, 4, 6 and 8 hours presented a strong association and closely agreement with inulin clearance. An abbreviated strategy was recommended with two blood sampling collected at 4 and 6 hours. In the second phase, 82 kidney transplanted patients were enrolled. Mean age was 43.4 ± 11.9 years. The majority were white (56%) and male (68%). The mean of the plasma clearance of 51Cr-EDTA was 50.6 ± 17.3, and it was 1.62 ± 0.65 mg/L and 1.40 ± 0.62 mg/dL for serum cystatin C and creatinine, respectively, at baseline. In cross-section analysis, serum cystatin C was strongly correlated with plasma clearance of 51Cr-EDTA. However, in longitudinal analysis serum cystatin C was not able for estimate GFR. CONCLUSIONS: Plasma clearance of 51Cr-EDTA is a precise method to measure GFR in renal transplanted recipients. The results showed that serial measurements of serum cystatin C are not able to detect trends in renal function in transplanted patients.
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Kaiser, Tiffany E. "An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967.
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He, Jiang, Michael Shlipak, Amanda Anderson, et al. "Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study." WILEY, 2017. http://hdl.handle.net/10150/625054.
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Background-Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. Methods and Results-Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P< 0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P= 0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P= 0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P< 0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P= 0.002), and tumor necrosis factor-a (1.10, 95% CI 1.00, 1.21, P= 0.05) were all significantly and directly associated with incidence of heart failure. Conclusions-Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease.
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McAuslane, James Alastair Neil. "Inulin and para-aminohippuric acid : determinants of glomerular filtration rate and renal blood flow following single intravenous bolus injection in man." Thesis, University of Edinburgh, 1990. http://hdl.handle.net/1842/24144.
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Camargo, Eduardo Guimarães. "Estimativa da taxa de filtração glomerular com equações baseadas na creatinina e cistatina C séricas em pacientes com diabete melito tipo 2." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/31876.
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As diretrizes nacionais e internacionais de nefrologia e diabetologia recomendam que, em pacientes com diabete melito (DM), além da aferição anual da excreção urinária de albumina, seja realizada a estimativa da TFG por meio de equações que incluam a creatinina sérica. As equações mais empregadas e analisadas têm sido as dos estudos MDRD (Modification of Diet in Renal Disease) e CKD-EPI (Chronic kidney Disease Epidemiology Collaboration). No entanto, algumas evidências demonstram um pior desempenho dessas equações em indivíduos com DM, com acentuada subestimativa da TFG. Este desempenho limitado parece estar relacionado a peculiaridades do paciente com DM, como a presença de hiperglicemia e hiperfiltração glomerular, mas também a limitações da própria creatinina como marcador pouco sensível e específico da TFG. O uso de novos marcadores endógenos com perfil mais próximo do ideal, como é o caso da cistatina C, tem se mostrado promissor, mas a sua acurácia ainda não foi adequadamente demonstrada no DM. O objetivo desse artigo foi analisar criticamente os métodos disponíveis de medida e de estimativa da TFG em pacientes com DM, enfatizando aspectos peculiares e possíveis interferentes.<br>The current guidelines of Nephrology and Diabetology recommend that in patients with diabetes mellitus (DM), along with the annual measure of urinary albumin excretion, the glomerular filtration rate (GFR) should be estimated using creatinine-based equations. The most frequently recommended equations were developed by the MDRD (Modification of Diet in Renal Disease) and CKDEPI (Chronic Kidney Disease Epidemiology Collaboration) studies. However, recent evidences show a worse performance of these equations in diabetic patients, with a significant underestimation of GFR. This limited performance seems to be related to the peculiarities of the patient with DM, such as the presence of hyperglycemia and glomerular hyperfiltration, but also due to the limitations in the sensitivity and specificity of serum creatinine as GFR marker. The use of new markers with closer–to-the ideal endogenous profile, like cystatin C, has shown promise, but its accuracy has not been yet adequately demonstrated in DM. The purpose of this article was to critically analyze the current available methods of measurement and estimation of GFR in patients with DM, emphasizing its peculiarities and possible interferences.
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Vieira, André Nanny Le Sueur. "Concentração sérica de dimetilarginina simétrica (SDMA) em cães com doença renal crônica submetidos a hemodiálise intermitente." Botucatu, 2018. http://hdl.handle.net/11449/180289.
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Orientador: Priscylla Tatiana Chalfun Guimarães-Okamoto<br>Resumo: A dimetilarginina simétrica (SDMA) é um aminoácido formado da metilação da arginina, liberada na corrente sanguínea durante a degradação proteica e excretada principalmente pela urina. Este aminoácido foi descoberto há 45 anos, presente na urina humana e estudado como possível biomarcador pela sua aparente estrita excreção renal e por suas concentrações serem altamente correlacionadas com a da taxa de filtração glomerular (TFG) em animais e seres humanos. Recentemente, este biomarcador foi validado e inserido na Medicina Veterinária pelo seu rico valor no diagnóstico precoce da doença renal crônica (DRC), assim como na sua monitoração ao longo da doença e também como um biomarcador alternativo na avaliação da TFG. Este trabalho visou avaliar o comportamento da SDMA em pacientes com DRC classificados no estádio 4 submetidos à terapia de hemodiálise intermitente e no grupo controle, bem como comparar e correlacionar seus valores com a creatinina sérica (sCr) em ambos os grupos. Foram avaliados 24 animais, todos previamente diagnosticados e classificados no estádio 4. SDMA e sCr foram avaliados antes e após os protocolos terapêuticos. Os resultados obtidos foram a diminuição da concentração sérica de SDMA e sCr após o tratamento dialítico. Já no grupo fluído houve a diminuição dos valores de sCr e inversamente, o aumento das concentrações séricas de SDMA. Assim, apesar do SDMA ser um excelente biomarcador de TFG e de diagnóstico precoce da DRC, este não pode ser utilizado para a... (Resumo completo, clicar acesso eletrônico abaixo)<br>Abstract: Symmetrical dimethylarginine (SDMA) is an amino acid formed from the methylation of arginine, released into the bloodstream during protein degradation and excreted primarily by urine. This amino acid was discovered 45 years ago in human urine and studied as a possible biomarker due to be strictly eliminated by renal excretion and its concentrations highly correlates with glomerular filtration rate (GFR) in animals and humans. Recently, this biomarker was validated and inserted in Veterinary Medicine for its rich value in the early diagnosis of chronic kidney disease (CKD) as well as its monitoring throughout the disease and as an alternative biomarker in the evaluation of GFR. This study aimed to evaluate the behavior of SDMA in dogs with CKD in stage 4 submitted to intermittent hemodialysis therapy and in the control group, as well as to compare and correlate their values with serum creatinine (sCr) in both groups. We evaluated 24 animals, all previously diagnosed and classified in stage IV. SDMA and sCr were evaluated before and after the therapeutic protocol. The results obtained were lower serum concentrations of SDMA and sCr after the dialytic treatment. However, in the fluid therapy group, inversely sCr levels lowered while SDMA serum concentrations increased . Thus, despite SDMA is an excellent biomarker of GFR and early diagnostic CKD, we do not recommend its use for diagnosis and follow up in dogs undergoing intermittent hemodialysis.<br>Mestre
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Rech, Dener Lizot. "Desempenho de equações baseadas na creatinina plasmática para estimar a taxa de filtração glomerular em idosos." reponame:Repositório Institucional da UCS, 2018. https://repositorio.ucs.br/handle/11338/3783.
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Netto, Rebeca Lugaresi Anadon Refusta dos Santos. "Efeitos da suplementação de creatina sobre a função renal de praticantes de treinamento de força: um estudo randomizado, duplo-cego, controlado por placebo." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/39/39132/tde-08102013-133955/.
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Os efeitos da suplementação de creatina sobre a função renal são debatidos intensamente na literatura científica. Os poucos trabalhos sobre o tema envolvendo humanos têm sido severamente criticados por apresentarem ausência de randomização, dosagens não uniformes de creatina, baixo poder estatístico e, sobretudo, ausência de marcadores padrão-ouro de função renal. Além disso, embora tenhamos mostrado recentemente que a suplementação de creatina não prejudica a função renal em sujeitos submetidos a treinamento aeróbio, a natureza desse tipo de atividade, bem como o habitual consumo de proteína dessa amostra, não permite que generalizemos nossos achados à população que mais utiliza creatina: praticantes de treinamento de força sob dietas ricas em proteína. Desta forma, foi conduzido um ensaio randomizado, duplo-cego, controlado por placebo, com o objetivo de investigar os efeitos da suplementação de creatina e sua possível interação com o alto consumo de proteínas sobre a função renal, em praticantes de treinamento de força. Os sujeitos foram divididos aleatoriamente em 2 grupos: a) suplementação de creatina (20g/dia durante cinco dias e 5g/dia até o término do estudo) e b) placebo (dextrose). No período basal e após 12 e 24 semanas, os sujeitos tiveram acompanhamento do consumo alimentar, e foram analisados o clearance de 51Cr-EDTA, creatinina sérica, sódio e potássio séricos e urinários e microalbuminúria. Não foram encontradas diferenças significativas nas variáveis analisadas após 12 e 24 semanas. Demonstrando assim, a ausência de alteração da função renal decorrente da suplementação de creatina, em praticantes de treinamento de força recreacionais com consumo proteico >=1,2g/kg peso/dia<br>The effects of creatine supplementation on renal function are discussed extensively in the literature. Few studies on the topic involving humans have been severely criticized because of the absence of randomization, non-uniform doses of creatine, low statistical power and, above all, the absence of a gold standard markers of renal function. Furthermore, although we have recently shown that creatine supplementation does not impair renal function in subjects undergoing aerobic training, the nature of this type of activity, as well as the usual protein intake in this sample does not allow generalization of our findings to the population who consume creatine: practitioners of strength training with a high protein intake. Thus, we conducted a randomized, double-blind, placebo-controlled study, in order to investigate the effects of creatine supplementation and its possible interaction with high protein intake on renal function in practicioners of strength training. The subjects were randomly assigned to 2 groups: a) creatine supplementation (20g/day during five days and 5g/day until the end of the study) and b) placebo (dextrose). At baseline and after 12 and 24 weeks, food intake, 51Cr-EDTA clearance, serum creatinine, sodium and potassium serum and urinary microalbuminuria was assessed. No significant differences were observed throughout the trial. Demonstrating that creatine supplementation on practitioners of strength training with high protein intake does not harm renal function
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Brum, Alexandre Martini de. "Avaliação da função renal de cães sadios e nefropatas crônicos sob diferentes bloqueios medicamentosos do sistema renina-angiotensina-aldosterona /." Jaboticabal : [s.n.], 2011. http://hdl.handle.net/11449/101235.
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Orientador: Marileda Bonafim Carvalho<br>Banca: Mácia Mery Kogika<br>Banca: Sandra Regina Ribeiro da Silva<br>Banca: Mirela Tinucci Costa<br>Banca: Áureo Evangelista Santana<br>Resumo: A função renal está sob influência de diversos hormônios, entre eles podemos citar o sistema renina-angiotensina-aldosterona (SRAA), que possui importante papel na manutenção do volume circulante e equilíbrio eletrolítico, entretanto também está relacionado com a progressão da doença renal. Entre seus efeitos deletérios, pode-se citar a hipertensão arterial e glomerular, proteinúria e glomeruloesclerose. Em Medicina, o tratamento medicamentoso da doença renal crônica consiste na utilização de inibidores da enzima conversora da angiotensina (iECA), antagonistas dos receptores da angiotensina II (ATAII) e/ou antagonistas da aldosterona, na forma de bloqueios simples, duplo ou triplo. Entretanto, somente o primeiro grupo de medicamentos é utilizado em Medicina Veterinária. Para testar a hipótese, que os bloqueios duplos e triplos possam beneficiar animais portadores de DRC, o presente estudo teve como objetivo avaliar a função renal de cães sadios e nefropatas submetidos a protocolos diferentes de inibição do SRAA. Os animais foram submetidos a terapias isoladas ou combinadas com cloridrato de benazepril, losartan potássico e espironolactona, durante sete dias, sendo avaliados no último dia. As avaliações consistiam em bioquímica sérica, urinálise, U-P/C, Ccr, metabolismo do sódio e potássio, além da PAS. Nos cães sadios, as terapias com benazepril (isolado ou associado) induziram aumento da concentração sérica de potássio, enquanto os bloqueios, duplo e triplo, reduziram a PAS. Nos nefropatas, todas as terapias reduziram a proteinúria, enquanto as terapias associadas reduziram a PAS e a excreção renal de potássio<br>Abstract: The renal function is under several hormones, like reninangiotensin- aldosterone system (RAAS), that have an important hole in the control of extravascular volume and electrolytic balance, however is related in the progression of renal disease, with proteinuria, glomerular hyperfiltration and glomerulosclerosis. In Medicine, the medical treatment of chronic renal failure consists in the use of ACE inhibitors, angiotensin II receptors antagonists (AIIRA) and/or aldosterone antagonists, however, only the first group is used in Veterinary Medicine. To prove the hypothesis that double or triple blockade can benefits animals with CRD, this study was conducted to evaluate the renal function of healthy dogs under different protocols of inhibition of RAAS. The dog received isolated ou associated therapies with benazepril, losartan and espironolactone, for seven days, with evaluation on the seventh Day. The evaluations consisted in serum biochemistry, urinalisis, UPC, Ccr, sodium and potassium metabolism, and SAP. In the healthy dog, the therapy with benazepril (isolated or associated) increased serum potassium levels, while the blockaded, duple or triple, decreased SAP. In nephropatic dogs, all therapies decreased proteinuria, while associated therapies decreased SAP and renal excretion of potassium<br>Doutor
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Gater, David Rex Jr. "The effects of arginine/lysine supplementation and resistance training on glucose tolerance and glomerular filtration rate: Relationship with alterations in selected hormonal parameters." Diss., The University of Arizona, 1990. http://hdl.handle.net/10150/185105.
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The purposes of this study were to evaluate and compare the independent and combined effects of arginine/lysine (AL) supplementation and resistance training (RT) on glucose tolerance and golmerular filtration rate, and to determine whether or not alterations were associated with changes in selected hormonal parameters. The study involved 30 physically active college males, ages 20-30 years, randomly assigned to one of four groups: Placebo/Control (P/C, n = 7), P/RT (n = 8), AL/C (n = 7), or AL/RT (n = 8). During the 10-week program, exercise subjects participated in a progressive resistance training program stressing all major muscle groups. An arginine/lysine supplement at a dosage of 132 mg/kg fat-free body (FFB) or placebo was administered to controls and training groups. Oral glucose tolerance (OGT) tests were performed on each subject before and after the 10-week intervention in order to evaluate resting levels of plasma insulin-like growth factor-1 (IGF-1), as well as resting levels and responses of glucose, insulin and glucagon for 180 minutes following an oral glucose challenge. Glomerular filtration rate (GFR) was determined from creatinine clearance (C(Cr)) as calculated from plasma creatinine, urine creatinine and urine flow. Significant increases in strength, and fat-free body (FFB) weight were seen in both resistance trained groups compared to controls, while supplement status had no apparent effect. Glucose tolerance parameters which significantly increased following the 10-week intervention included resting insulin for P/RT and glucagon area under the curve (AUC) for P/C, AL/C, and P/RT. While IGF-1 did not significantly increase within groups, a significant post-treatment difference was seen between P/RT (0.93 ± 0.10 U/ml) and AL/RT (0.60 ± 0.08 u/ml); percent carbohydrate in diet and absolute change in FFB were significant predictors of the absolute change in IGF-1, accounting for 22.0% (p < 0.01) and 20.8% (p < 0.01) of the variability, respectively. It was concluded that AL supplementation for 10 weeks had no significant effect on strength, FFB, OGT or GFR, while RT increased both strength and FFB with no significant effect on OGT or GFR.
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VALENÇA, Andréa Camello Esteves Perrelli. "Associação entre alterações cardíacas e taxa de filtração glomerular estimada pela creatinina e cistatina c em pacientes com doença renal crônica sob tratamento conservador." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/18426.
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Previous issue date: 2016-08-31<br>A doença renal crônica (DRC) caracteriza-se por perda irreversível e progressiva da função renal, definida por redução da taxa de filtração glomerular (TFG) ou alteração renal estrutural. É bastante prevalente no Brasil e no mundo e está associada a alta morbimortalidade por doença cardiovascular (DCV). Apesar de ser a principal causa de mortalidade, a DCV nestes pacientes com frequência é subdiagnosticada e subtratada. Estudos mostram que a prevalência de alterações cardíacas aumenta a medida que ocorre declínio da função renal. A forma mais frequentemente utilizada para estimar a TFG é através da dosagem sérica da creatinina. No entanto, a cistatina C tem se sobressaído como marcador mais fidedigno por apresentar vantagens em relação à creatinina, como por exemplo, não sofrer influência de massa muscular, sexo ou idade. Entretanto, estudos sugerem que a TFG calculada pela combinação das medidas da creatinina e da cistatina C é mais precisa do que as medidas isoladas. O uso combinado destes marcadores pode ser útil para distinguir melhor os estágios de disfunção renal e, desta maneira, identificar mais precocemente a necessidade de estudo ecodopplercardiográfico para detecção de alterações cardíacas subclínicas estruturais e funcionais. Objetivou-se realizar um estudo de corte transversal em pacientes com DRC em tratamento conservador avaliando a TFG estimada pela creatinina, cistatina C e combinação de ambas e suas associações com alterações cardíacas. Os pacientes foram classificados em estágios da DRC, de acordo com as diretrizes do Kidney Disease Impoving Global Outcomes e com a TFG estimada, utilizando a equação Chronic Kidney Disease Epidemiology Collaboration, através das medidas séricas da creatinina e da cistatina C. Para critério de comparação os pacientes classificados em estágios 3a, 3b e 4 foram considerados grupo 1 e os pacientes do estágio 5, grupo 2. As alterações ecodopplercardiográficas avaliadas incluíram: disfunção diastólica, disfunção sistólica, alterações de geometria do ventrículo esquerdo (VE) e disfunção valvar. Foram avaliados 140 pacientes, em um único centro de referência em nefrologia, por um período de 6 meses. Quando a TFG foi estimada pela cistatina C, observou-se associação inversa entre o grau de disfunção renal e a presença de alteração de geometria do VE (45,4% no grupo 1 e 87,5% no grupo 2, p = 0,028) e disfunção valvar (8,3% no grupo 1 e 50 % no grupo 2, p = 0,005). Essa associação não foi observada quando a TFG foi estimada pela creatinina ou pela combinação de creatinina e cistatina C. Não houve associação entre o grau de disfunção renal e a presença de disfunção diastólica e disfunção sistólica. Concluiu-se que a TFG estimada pela combinação de creatinina e cistatina C não foi
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superior ao uso isolado dos marcadores em predizer alterações ecodopplercardiográficas em pacientes portadores de DRC em tratamento conservador.<br>Chronic kidney disease (CKD) is characterized by irreversible and progressive loss of renal function with decreased glomerular filtration rate (GFR) or renal structural damage. CKD is a common disease in Brazil and worldwide and it is associated with high morbidity and mortality rates, mainly due to cardiovascular disease (CVD). Despite being the main cause of mortality among CKD patients, CVD is often underdiagnosed and undertreated. Several studies have shown that the prevalence of cardiac abnormalities increases as the renal function declines. GFR has been most frequently calculated with the dosage of serum creatinine. However, cystatin C has been considered as the most reliable GFR marker as it presents advantages over creatinine, since it is not influenced by muscle mass, sex, or age. Recent studies have shown that estimated GFR, calculated with a combination of creatinine and cystatin C, more accurately reflects measured GFR than either marker alone. This finding suggests that the combined use of these two markers may be useful to distinguish kidney dysfunction stages better than either marker alone, and subsequently, allowing the earlier identification for the need of a Doppler echocardiography performance test in order to detect subclinical cardiac structural and functional changes. Thus, a cross-sectional study was conducted in patients with CKD undergoing conservative treatment evaluating estimated GFR by the creatinine, cystatin C, and combination of both markers, and their association with cardiac changes. Patients were classified in the CKD stages, according to KDIGO guidelines (Kidney Disease impoving Global Outcomes) and the GFR was estimated using the CKD-EPI equation (Chronic Kidney Disease - Epidemiology Collaboration) through serum measurements of creatinine and cystatin C. For comparison criteria patients classified in stages 3a, 3b and 4 were considered as group 1 and patients in stage 5 as group 2. The Doppler echocardiographic changes evaluated included: diastolic dysfunction, systolic dysfunction, left ventricular geometry abnormalities and valvular dysfunction. We evaluated 140 patients in a single center of reference in nephrology, for a 6 months period. When GFR was estimated by cystatin C, we observed an inverse association between the degree of renal dysfunction and the presence of left ventricular geometry change (45.4% in group 1 and 87.5% in group 2, p = 0.028) and valvular dysfunction (8.3% in group 1 and 50% in group 2, p = 0.005). This association was not observed when GFR was estimated by creatinine or the combination of creatinine and cystatin C. There was no association between the degree of renal dysfunction and diastolic dysfunction or systolic dysfunction. It was concluded that the GFR estimated by combining creatinine and cystatin C was not greater than the isolated use
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of markers to predict cardiac changes in patients with CKD undergoing conservative treatment.
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Novo, Ana Carolina de Albuquerque Cavalcanti Ferreira. "Evolução dos níveis séricos de cistatina C em recém-nascidos de termo no primeiro mês de vida." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-01062009-100958/.
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INTRODUÇÃO: A cistatina C sérica apresenta boa correlação com o ritmo de filtração glomerular (RFG) e não é influenciada pela função renal materna, podendo ser um bom marcador da função renal, especialmente na 1ª semana de vida. Porém, não há valores normais definidos para o período neonatal. OBJETIVO: Determinar a evolução dos níveis séricos da cistatina C (Cis) em recém-nascidos (RN) de termo saudáveis ao longo do 1º mês de vida. MÉTODOS: Estudo prospectivo. Inclusão: idade gestacional (IG) entre 37 e 41 6/7 semanas; peso de nascimento adequado para a IG; Apgar 1º min > 7; mães sem insuficiência renal, hipertensão arterial ou uso de drogas que interferissem com a função renal do feto. Exclusão: má-formação major ou renal; ausência de diurese nas primeiras 12 horas de vida ou diurese no 2° ou 3° dia < 1mL/kg/h; perda de peso > 10% até o 3º dia; pressão arterial elevada; insuficiência cardíaca ou renal, fototerapia, infecção, alteração da função tireoidiana ou uso de drogas vasoativas ou diuréticos. Dosagens laboratoriais: Cis (mg/L) por imunonefelometria e creatinina sérica (Cr) (mg/dL) pelo método de Jaffé, da mãe e do RN, no cordão umbilical (d0) e com 3 (d3), 7 (d7) e 28 (d28) dias. O clearance de creatinina foi estimado pela fórmula de Schwartz (mL/min/1,73m2). Comparação de médias pelo teste ANOVA one way para medidas repetidas e teste de Tukey. Análise de correlação pelo coeficiente de correlação de Pearson. Nível de significância=0,05. RESULTADOS: Preencheram os critérios de inclusão 35 RN e, destes, 14 foram excluídos. Foram analisados 21 RN. Mães: idade (média): 29,1 anos. Os RN apresentaram IG (mediana) de 39,4 sem e peso (média) de 3224 g; 57,1% eram do sexo masculino. A diurese (média) no 2° e no 3° dias foi 2,1 e 2,4 mL/kg/h, respectivamente, e a perda de peso máxima (média) foi 7,1% e ocorreu com 2 dias (mediana). Dos 21 RN, 17 (81%) receberam aleitamento materno exclusivo e 13 (61,9%) tiveram icterícia. Cis (média±dp): mãe: 1,00±0,20; RN: d0=1,70±0,26; d3=1,51±0,19; d7=1,54±0,15; d28=1,51±0,15. Cr (média±dp): mãe: 0,63±0,15; RN: d0=0,63±0,15; d3=0,48±0,16; d7=0,37±0,10; d28=0,26±0,05. Os valores de Cr não foram diferentes dos encontrados na literatura para RN de termo saudáveis. A Cr da mãe não foi diferente de d0, enquanto a Cis materna foi menor do que em d0 (p<0,001). A Cr no RN diminuiu com o tempo (d0xd3, p=0,007; d3xd7, p=0,002; d7xd28, p<0,001). A Cis diminuiu de d0 para d3 (p=0,004) e manteve-se estável após d3. A Cis e a Cr da mãe apresentaram correlação positiva. Houve correlação positiva entre Cis e Cr em d3 e d28. CONCLUSÕES: A Cis do RN, que ao nascimento foi maior do que a da mãe, reduziu-se até d3 e permaneceu estável até d28. A Cis e a Cr da mãe correlacionaram-se entre si. Em d3 e d28 houve correlação entre Cis e Cr do RN.<br>INTRODUCTION: Cystatin C (Cys) is a good marker of glomerular filtration rate (GFR), and is not affected by maternal renal function. OBJECTIVE: To determine the levels of Cys in healthy term newborns (NB), along the 1st month of life. METHODS: Cohort study. Inclusion: term NB with appropriate weight; 1st min Apgar > 7; mother without renal failure or drugs that could affect fetal GFR. Exclusion: malformations; hypertension; no diuresis in the first 12 hours of life or oliguria in the first three days; excessive weight loss until the third day; heart or kidney failure; thyroid dysfunction; use of diuretics, vasoactive drugs or any drug that could affect renal function. Cys (mg/L) and creatinine (Cr) (mg/dL) were determined in the mother (Mo) and in the NB at birth (d0), 3rd (d3), 7th (d7) and 28th (d28) days. Creatinine clearance was estimated in the NB using the Schwartz formula. Statistics: one way ANOVA and Pearsons correlation tests. Significance level=0.05. RESULTS: Data from 21 NB were obtained. Mothers: age (mean): 29.1 years. NB: gestational age (median): 39.4 weeks; birth weight (mean): 3224 g; 57.1% were male. Diuresis (mean) in the 2nd and 3rd days of life: 2.1±0.6 and 2.4±0.7 mL/kg/h, respectively. Maximum weight loss (mean): 7.1%; it occurred in the 2nd day (median). 81% of the NB were breastfed and 61.9% had jaundice. Cys (mean±sd): Mo: 1.00±0.20; NB: d0=1.70±0.26; d3=1.51±0.19; d7=1.54±0.15; d28=1.51±0.15. Cr (mean±sd): Mo: 0.63±0.15; NB: d0=0.63±0.15; d3=0.48±0.16; d7=0.37±0.10; d28=0.26±0.05. These Cr values are similar to those found in the literature for healthy term NB. Mo Cr was not different from d0 Cr, while Mo Cys was lower than d0 Cys (p<0.001). NB Cr decreased (d0xd3, p=0.007; d3xd7, p=0.002; d7xd28, p<0.001) along the time, while Cys decreased from d0 to d3 (p=0.004). Correlations were obtained between Mo Cr and Mo Cys, as well as d3 Cr and d3 Cys, d28 Cr and d28 Cys. CONCLUSIONS: At birth, NB Cys values were higher than Mo Cys values. NB Cys decreased from d0 to d3 and remained stable from d3 to d28. Mo Cys correlated with Mo Cr and NB Cys correlated with NB Cr at d3 and d28.
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Dias, Cristiano. "Rosiglitazone pode causar lesão tubular renal em ratos normais mas não em ratos hipercolesterolêmicos." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5148/tde-25022010-160938/.
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Introdução: Rosiglitazone (RGL) é um ligante dos receptores PPAR e vem sendo usada no tratamento do Diabetes Mellitus tipo 2 e nas doenças inflamatórias. Mas, RGL pode reduzir a filtração glomerular (FG), a carga excretada de sódio na urina (UVNa) e aumentar a expressão da Na+,K+- ATPase na medula renal. Então, RGL pode causar edema e insuficiência cardíaca congestiva. Entretanto, não tem sido reportado se RGL pode induzir insuficiência renal aguda (IRA). Objetivo: Verificar se a redução da FG causada pelo tratamento com RGL predispõe à IRA em ratos. Avaliar em condições basais e de vasoconstrição renal e se há diferenças entre ratos normocolesterolêmicos (NC) e hipercolesterolêmicos (HC). Métodos: A FG foi medida pelo clearance de inulina no 8º dia em ratos (~200g) NC e HC tratados ou não com RGL (48 mg/kg/dieta) na situação basal e durante a infusão endovenosa de Ang II (40 ng/kg/min). Além disso, a atividade da Na+,K+-ATPase foi avaliada em homogenato renal em outra série de animais. Resultados: Na situação basal, NC e HC apresentaram FG semelhante e o tratamento com RGL reduziu a FG apenas em NC de 0,78±0,03 para 0,50±0,05* ml/min/100g, *p<0,001. Apesar da redução da FG, a UVNa em NC+RGL não se modificou. Durante a infusão de Ang II, a FG de NC, HC e HC+RGL reduziu-se para o mesmo patamar de NC+RGL e um significante aumento da UVNa foi observada apenas em NC+RGL (NC= 3,32±0,88; NC+RGL=5,86±1,04*; HC= 2,63±0,43 e HC+RGL= 2,23±0,39 uEq/min, *p<0,01). Além disso, RGL induziu aumento na atividade da Na+,K+-ATPase em HC+RGL e não modificou em NC+RGL. Os valores expressos em M Pi/mg proteína.h-1 foram de 45±7 em NC, 43±5 em NC+RGL, 48±7 em HC e 64±4* em HC+RGL, *p<0,05. Analisando todos os resultados em conjunto, a redução da FG associada com a alta natriurese e ausência da modulação da atividade da Na+,K+-ATPase em NC+RGL sugerem lesão renal neste grupo. Conclusão: Os mecanismos de ação da RGL diferem de acordo com a condição metabólica. Então, RGL deve ser prescrita com cautela na ausência de hipercolesterolemia e requer a monitoração da função renal principalmente nas situações de vasoconstrição<br>Introduction: Rosiglitazone (RGL) is a ligand for PPAR used to treat type 2 Diabetes Mellitus and inflammatory diseases. However, RGL can reduce the glomerular filtration rate (GFR), urinary sodium excretion (UVNa) and increase the expression of Na+, K+-ATPase in renal medulla. Thus, RGL may induce edema and congestive heart failure. However, acute renal failure (ARF) provoked by RGL treatment has not been reported. Aim: To test whether reduced GFR by RGL may predispose to ARF at baseline and during a renal vasoconstriction state, and if the findings differ between normocholesterolemic (NC) and hypercholesterolemic (HC) rats. Methods: GFR was measured by inulin clearance on the 8th day in NC and HC rats (~200g) treated or not with RGL (48 mg/kg diet) at baseline and during intravenous infusion of Ang II (40 ng/kg/min). Furthermore, the Na+,K+- ATPase activity was determined in renal homogenates in other series of animals. Results: At baseline, NC and HC had similar GFR and the treatment with RGL reduced GFR only in NC from 0.78±0.03 to 0.50±0.05* ml/min/100g, *p<0.001. Although GFR was reduced, UVNa was unchanged in NC+RGL. During Ang II infusion, GFR was significantly reduced in NC, HC and HC+RGL and it remained at the same reduced level in NC+RGL. At this time, when GFR was reduced the same range in all groups, a significant increment in UVNa was only observed in NC+RGL (NC = 3.32±0.88; NC+RGL = 5.86±1.04*; HC = 2.63±0.43 and HC+RGL = 2.23±0.39 Eq/min, *p<0.01). Moreover, RGL induced an increase in the activity of Na+, K+-ATPase in HC+RGL, but it did not modify the activity of this enzyme in NC+RGL. The values expressed in M Pi/mg.protein.h-1 were 45±7 in NC, 43±5 in NC+RGL, 48±7 in HC and 64±4* in HC+RGL, *p<0.05. Taken together, reduction in GFR associated with high natriuresis and without changes in the Na+, K+-ATPase activity in renal medulla of NC+RGL may suggest renal injury in this group. Conclusion: RGL may act distinctly in normocholesterolemia and in hypercholesterolemia. Thus, RGL may be prescribed with caution in absence of hypercholesterolemia and requires monitoring of renal function specially if a renal vasoconstriction state is associated.
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Brum, Alexandre Martini de [UNESP]. "Avaliação da função renal de cães sadios e nefropatas crônicos sob diferentes bloqueios medicamentosos do sistema renina-angiotensina-aldosterona." Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/101235.
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brum_am_dr_jabo.pdf: 622972 bytes, checksum: 0b01eae13341e55c681978fe0a28fb60 (MD5)<br>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)<br>A função renal está sob influência de diversos hormônios, entre eles podemos citar o sistema renina-angiotensina-aldosterona (SRAA), que possui importante papel na manutenção do volume circulante e equilíbrio eletrolítico, entretanto também está relacionado com a progressão da doença renal. Entre seus efeitos deletérios, pode-se citar a hipertensão arterial e glomerular, proteinúria e glomeruloesclerose. Em Medicina, o tratamento medicamentoso da doença renal crônica consiste na utilização de inibidores da enzima conversora da angiotensina (iECA), antagonistas dos receptores da angiotensina II (ATAII) e/ou antagonistas da aldosterona, na forma de bloqueios simples, duplo ou triplo. Entretanto, somente o primeiro grupo de medicamentos é utilizado em Medicina Veterinária. Para testar a hipótese, que os bloqueios duplos e triplos possam beneficiar animais portadores de DRC, o presente estudo teve como objetivo avaliar a função renal de cães sadios e nefropatas submetidos a protocolos diferentes de inibição do SRAA. Os animais foram submetidos a terapias isoladas ou combinadas com cloridrato de benazepril, losartan potássico e espironolactona, durante sete dias, sendo avaliados no último dia. As avaliações consistiam em bioquímica sérica, urinálise, U-P/C, Ccr, metabolismo do sódio e potássio, além da PAS. Nos cães sadios, as terapias com benazepril (isolado ou associado) induziram aumento da concentração sérica de potássio, enquanto os bloqueios, duplo e triplo, reduziram a PAS. Nos nefropatas, todas as terapias reduziram a proteinúria, enquanto as terapias associadas reduziram a PAS e a excreção renal de potássio<br>The renal function is under several hormones, like reninangiotensin- aldosterone system (RAAS), that have an important hole in the control of extravascular volume and electrolytic balance, however is related in the progression of renal disease, with proteinuria, glomerular hyperfiltration and glomerulosclerosis. In Medicine, the medical treatment of chronic renal failure consists in the use of ACE inhibitors, angiotensin II receptors antagonists (AIIRA) and/or aldosterone antagonists, however, only the first group is used in Veterinary Medicine. To prove the hypothesis that double or triple blockade can benefits animals with CRD, this study was conducted to evaluate the renal function of healthy dogs under different protocols of inhibition of RAAS. The dog received isolated ou associated therapies with benazepril, losartan and espironolactone, for seven days, with evaluation on the seventh Day. The evaluations consisted in serum biochemistry, urinalisis, UPC, Ccr, sodium and potassium metabolism, and SAP. In the healthy dog, the therapy with benazepril (isolated or associated) increased serum potassium levels, while the blockaded, duple or triple, decreased SAP. In nephropatic dogs, all therapies decreased proteinuria, while associated therapies decreased SAP and renal excretion of potassium
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Compagnon, Milton Cezar. "Microalbuminúria como preditor de doença cardiovascular e renal em pacientes e em um modelo experimental esquistossomóticos." Universidade Federal de Pernambuco, 2013. https://repositorio.ufpe.br/handle/123456789/17099.
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Previous issue date: 2013-02-27<br>A esquistossomose é uma doença crônica e debilitante que afeta cerca de 240 milhões de pessoas em todo o mundo e outras 700 milhões vivem em áreas endêmicas de países em desenvolvimento, o que tem sido um problema de saúde pública. Em 2009, havia 6.780.683 casos confirmados da doença no Brasil. A esquistossomose crônica pode levar a processos inflamatórios hepáticos graves, desencadear distúrbios renais e danos celulares que incluem o aumento do estresse oxidativo e a disfunção endotelial. Isto contribui para o surgimento da microalbuminúria, uma perda de proteínas que pode ser um preditor precoce de doenças cardiovasculares e renais. Neste estudo, foi investigado em 130 pacientes com esquistossomose hepatoesplênica ou hepatointestinal a ocorrência de microalbuminúria, e sua correlação com o aumento dos níveis pressóricos. A função renal também foi avaliada utilizando biomarcadores (Cistatina C / Creatinina) e estimada através da medida da taxa de filtração glomerular. Os valores obtidos foram comparados com 40 pessoas (Grupo Controle) saudáveis, advindos das mesmas classes sociais. Por fim, foi investigado em ratos infectados pelo parasita Schistosoma mansoni, a elevação da pressão arterial, a ocorrência de proteinúria, o estresse oxidativo renal e o estresse oxidativo hepático. Dos 130 pacientes (grupo Schistosoma mansoni) avaliados, 14,6% (11 homens e 8 mulheres) apresentaram microalbuminúria (valores entre 30 e 300 mg / g de creatinina) em comparação ao grupo controle, que mostrou apenas 5 % (um homem e uma mulher) com microalbuminúria. Dos 19 pacientes que apresentaram microalbuminúria, 15 tinham esquistossomose hepatoesplênica, e 4 tinham esquistossomose hepatointestinal. A taxa de filtração glomerular renal e a pressão arterial aumentaram no grupo Schistossoma mansoni em relação ao Grupo Controle. O resultado obtido na avaliação da taxa de filtração glomerular com a Cistatina C sérica foi superior ao resultado obtido com a Creatinina sérica. No estudo realizado com animais, os ratos infectados pelo parasita Schistossoma mansoni tiveram aumento da pressão arterial e perda de proteína na urina em comparação ao grupo controle. Este processo foi mais intenso em animais infectados e tratados com sobrecarga de sódio. Os animais não infectados pelo parasita Schistossoma mansoni e que não foram tratados com a sobrecarga de sódio, não tiveram proteinúria, nem aumento dos níveis pressóricos. Todos os resultados obtidos permitem sugerir que a microalbuminúria pode ser utilizada como um novo marcador não invasivo para o diagnóstico precoce de hipertensão arterial e de glomerulopatia esquistossomótica.<br>Schistosomiasis is a debilitating chronic disease that affects nearly 240 million people around the world and another 700 million live in endemic areas in developing countries, representing a serious public health issue. In 2009, there were 6,780,683 confirmed cases of the disease in Brazil. Chronic schistosomiasis can lead to severe hepatic inflammatory processes, and trigger kidney dysfunction and cellular damage, including an increase of oxidative stress and endothelial dysfunction. This contributes to the appearance of microalbuminuria, a loss of proteins that may serve as an early predictor of cardiovascular and kidney diseases. This study investigated the occurrence of microalbuminuria in 130 patients with hepatosplenic or hepatointestinal schistosomiasis, and its correction with the increase of pressure levels. Kidney function was also evaluated using biomarkers (Cystatin C / Creatinine) and estimated through the measurement of the glomerular filtration rate. The values obtained were compared with 40 healthy persons (Control Group) from the same social classes. Finally, the study investigated – in rats infected by the Schistosoma mansoni parasite – the elevation of arterial pressure, the occurrence of proteinuria, kidney oxidative stress and hepatic oxidative stress. From the 130 patients (Schistosoma mansoni group) evaluated, 14.6% (11 men and 8 women) presented microalbuminuria (values between 30 and 300 mg / g of creatinine) in comparison to the Control Group, which showed only 5% (one man and one woman) as having microalbuminuria. From the 19 patients who presented microalbuminuria, 15 had hepatosplenic schistosomiasis, and 4 had hepatointestinal schistosomiasis. The kidney glomerular filtration rate and the arterial pressure increased in the Schistossoma mansoni group in relation to the Control Group. The result obtained from the evaluation of the glomerular filtration rate with serum Cystatin C, was higher than that obtained with serum Creatinine. In the study carried out with animals, the rats infected by the Schistossoma mansoni parasite had an increase in arterial pressure and loss of protein in the urine, compared with the Control Group. The animals that were not infected with the Schistossoma mansoni parasite and that were not treated with a sodium overload, did not have proteinuria or an increase in the pressure levels. All the results obtained suggest that microalbuminuria may be used as a new non-invasive marker for early diagnosis of arterial hypertension and schistosomal glomerulopathy.
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Verner, Marc-André, Anne E. Loccisano, Nils-Halvdan Morken, et al. "Associations of Perfluoroalkyl Substances (PFASs) with Lower Birth Weight: An Evaluation of Potential Confounding by Glomerular Filtration Rate Using a Physiologically Based Pharmacokinetic Model (PBPK)." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/28.
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Background: Prenatal exposure to perfluoroalkyl substances (PFAS) has been associated with lower birth weight in epidemiologic studies. This association could be attributable to glomerular filtration rate (GFR), which is related to PFAS concentration and birth weight.
Objectives: We used a physiologically based pharmacokinetic (PBPK) model of pregnancy to assess how much of the PFAS–birth weight association observed in epidemiologic studies might be attributable to GFR.
Methods: We modified a PBPK model to reflect the association of GFR with birth weight (estimated from three studies of GFR and birth weight) and used it to simulate PFAS concentrations in maternal and cord plasma. The model was run 250,000 times, with variation in parameters, to simulate a population. Simulated data were analyzed to evaluate the association between PFAS levels and birth weight due to GFR. We compared simulated estimates with those from a meta-analysis of epidemiologic data.
Results: The reduction in birth weight for each 1-ng/mL increase in simulated cord plasma for perfluorooctane sulfonate (PFOS) was 2.72 g (95% CI: –3.40, –2.04), and for perfluorooctanoic acid (PFOA) was 7.13 g (95% CI: –8.46, –5.80); results based on maternal plasma at term were similar. Results were sensitive to variations in PFAS level distributions and the strength of the GFR–birth weight association. In comparison, our meta-analysis of epidemiologic studies suggested that each 1-ng/mL increase in prenatal PFOS and PFOA levels was associated with 5.00 g (95% CI: –21.66, –7.78) and 14.72 g (95% CI: –8.92, –1.09) reductions in birth weight, respectively.
Conclusion: Results of our simulations suggest that a substantial proportion of the association between prenatal PFAS and birth weight may be attributable to confounding by GFR and that confounding by GFR may be more important in studies with sample collection later in pregnancy.
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Samnegård, Björn. "Renal effects of C-peptide in experimental type-1 diabetes mellitus /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-502-X/.
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Schütz, Jasper da Silva. "Doença periodontal como possível preditor da condição renal em pacientes pré-dialíticos : um estudo transversal." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/151432.
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Objetivo: O objetivo do presente estudo foi avaliar o impacto da doença periodontal sobre a função renal em pacientes pré–dialíticos nos estágios 3, 4 e 5 da doença renal crônica (DRC). Metodologia: Dados demográficos, socioeconômicos e de história médica de 139 pacientes do Serviço Nefrologia do Hospital de Clínicas de Porto Alegre (HCPA) foram obtidos por meio de entrevista e análise de prontuário. Exames clínicos periodontais completos foram realizados por examinadores treinados e calibrados. Foram realizadas associações entre a condição periodontal e os diferentes estágios da DRC e com a taxa de filtração glomerular (TFG). Resultados: Ter periodontite grave aumentou em, aproximadamente, 2,8 e 3,4 vezes a chance de estar nos estágios 4 e 5 da DRC quando comparado a estar no estágio 3 (referência), respectivamente (p<0,05). Além disso, ter dois ou mais dentes com perda de inserção maior ou igual a 6mm aumentou em 3,9 vezes a chance de estar no estágio 5 da DRC (p<0,05). Com relação à TFG, tanto o fato de ter periodontite grave quanto o de apresentar dois ou mais dentes com perda de inserção maior ou igual a 6mm estiveram significativamente associados a uma menor taxa de filtração glomerular (p=0,02 e p=0,01, respectivamente). Conclusão: A doença periodontal aumenta a chance de piores desfechos renais em pacientes com DRC pré-dialiticos, mesmo quando ajustado para importantes confundidores.<br>Aims: The aim of the present study was to evaluate the impact of periodontal disease on renal function in pre-dialytic patients in stages 3, 4 and 5 of chronic kidney disease (CKD). Materials and Methods: Demographic, socioeconomic and medical history data of 139 patients from the Nephrology Service at the Hospital de Clínicas de Porto Alegre (HCPA) were obtained through interview and clinical records. Complete periodontal clinical examinations were performed by trained and calibrated examiners. Associations between the periodontal condition and different stages of CKD, as well as with the glomerular filtration rate (GFR) were evaluated. Results: Severe periodontitis increased by 2.8 and 3.4 times the chance of being in stages 4 and 5 of CKD when compared to the reference (stage 3), respectively (p <0.05). In addition, having two or more teeth with clinical attachment loss ≥6mm increased by 3.9 times the probability of being in stage 5 of the CKD (p <0.05). Regarding GFR, severe periodontitis and having two or more teeth with clinical attachment loss ≥6mm were significantly associated with a lower glomerular filtration rate (p = 0.02 and p = 0.01, respectively). Conclusion: Periodontal disease increases the chance of worse renal outcomes in patients with pre-dialytic CKD, even when adjusted for major confounders.
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Caielli, Paola. "Atherosclerotic Renovascular hypertension: Results of The METRAS study (Medical and Endovascular Treatment of Atherosclerotic Renal Artery Stenosis)." Doctoral thesis, Università degli studi di Padova, 2015. http://hdl.handle.net/11577/3424179.
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Background: Despite the results of some randomized controlled trials in the last 5 years it remains unclear whether revascularization of atherosclerotic renal artery stenosis (ARAS) by means of percutaneous renal angioplasty and stenting (PTRAS) is advantageous over optimal medical therapy. Materials and methods: The METRAS study was designed with the primary objective to determine whether PTRAS is superior or equivalent to optimal medical treatment for preserving glomerular filtration rate (GFR) in the ischemic kidney, as assessed by 99mTc-DTPA renal scintigraphy. Secondary objectives were to establish whether the two treatments are equivalent in lowering blood pressure, preserving overall renal function and regressing target organ damage. Results: At 2 years follow-up compared to the medical treatment in the endovascular group GFR in the ischemic kidney was higher (p=0.027). Moreover, 24 hours DBP was lower in PTRAS group compared to medical therapy at 3 years follow-up (p=0.029). Of note, this difference occurred despite borderline significant (p=0.055) lower need for number of antihypertensive drugs. Both serum creatinine and cystatin-c were lower in PTRAS group compared to medical therapy (p=0.035 and p=0.02, respectively). HBA1c was also lower in PTRAS group compared to medical therapy (p=0.034). Left ventricular mass index, as assessed by echocardiography, was also borderline significant (p=0.058) lower in the PTRAS group. Diastolic dysfunction, as assessed by E/E’ ratio at tissue Doppler, improved in the PTRAS group compared to medical therapy (p=0.011). Conclusions: In the carefully selected patients with atherosclerotic renovascular hypertension of the METRAS study PTRAS on top of optimal medical therapy provided an improvement in GFR in the ischemic kidney and a better DBP control despite a lower need of antihypertensive drugs compared to optimally treated patients receiving medical therapy only.<br>Background: la stenosi delle arterie renali è una delle cause principali d'insufficienza renale e d’ipertensione arteriosa secondaria. Studi epidemiologici hanno dimostrato che la stenosi dell’arteria renale su base aterosclerotica implica non solo un elevato profilo di rischio cardiovascolare, ma anche un'aumentata incidenza di morbilità e mortalità per stroke, cardiopatia ischemica e arteriopatia periferica. La rivascolarizzazione percutanea con angioplastica transluminale e stenting è divenuta il trattamento di scelta, per lo meno nei pazienti in cui la terapia medica non consente un soddisfacente controllo dei valori pressori e per i quali è presumibile che la rivascolarizzazione possa ritardare o prevenire il declino della funzione renale. La reale utilità di tale costosa procedura rimane, tuttavia, fortemente dibattuta, poiché gli studi clinici prospettici randomizzati di confronto fra trattamento endovascolare e sola terapia medica pubblicati fino ad ora non sono stati conclusivi nel dimostrare una superiorità di un trattamento sull’altro. Materiali e metodi: lo studio METRAS è stato disegnato con l’obiettivo primario di determinare se la rivascolarizzazione sia superiore o equivalente alla sola terapia medica nel preservare la funzione renale nel rene ischemico valutata con la scintigrafia renale al 99mTc-DTPA nei pazienti con stenosi aterosclerotica delle arterie renali. Obiettivi secondari includono il controllo pressorio, la preservazione della funzione renale globale e la regressione del danno d’organo. Risultati: nel gruppo trattato con terapia endovascolare la GFR nel rene ischemico misurata alla scintigrafia è risultata più alta rispetto al gruppo in terapia medica a 2 anni di follow-up (p=0.027). La pressione diastolica nelle 24 ore è risultata inferiore nel gruppo in trattamento endovascolare rispetto al braccio in terapia medica a 3 anni di follow-up (p=0.029) a fronte di un minore utilizzo di farmaci antipertensivi nel braccio endovascolare (p=0.055). I livelli di creatinina, cistatina-c ed emoglobina glicata sono risultati inferiori nei pazienti nel braccio endovascolare rispetto ai pazienti in sola terapia medica (rispettivamente p=0.035, p=0.020, e p=0.034). La massa ventricolare sinistra normalizzata per altezza è risultata inferiore nei pazienti trattati con trattamento endovascolare rispetto ai pazienti in terapia medica, seppur la significatività sia borderline (p=0.058) a fronte di un miglioramento della disfunzione diastolica, espressa come rapporto E/E’, in questo gruppo di pazienti rispetto al braccio in terapia medica (p=0.011). Conclusioni: lo studio METRAS ha dimostrato un miglioramento della GFR nel rene ischemico, un migliore controllo pressorio in termini di pressione diastolica nelle 24 ore ed un minor fabbisogno di farmaci antipertensivi nei pazienti trattati con angioplastica e stenting rispetto al gruppo in sola terapia medica.
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Santana, Davi Alves de. "Efeitos agudos do exercício físico aeróbio sobre a função renal de pacientes com doença renal crônica não dialíticos." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5164/tde-06032017-104953/.
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INTRODUÇÃO: O exercício físico pode ser uma terapia coadjuvante para indivíduos com doença renal crônica (DRC), já que esta condição patológica tem sido associada a múltiplas comorbidades como hipertensão e diabetes mellitus. No entanto, pouco se sabe sobre os efeitos agudos do exercício sobre a função renal em pacientes com DRC em seus diferentes estágios. OBJETIVO: O objetivo deste estudo foi investigar os efeitos agudos do exercício aeróbico sobre a função renal em pacientes com DRC não dialíticos. MÉTODOS: Trinta e três indivíduos foram divididos em três grupos: i) pacientes nos estágios 1 e 2 (DRC1-2; n= 11); ii) estágios 3 e 4 (DRC3-4; n= 11); iii) indivíduos saudáveis (CON; n= 11). Todos os voluntários realizaram 30 minutos de exercício em esteira em intensidade correspondente ao limiar anaeróbio ventilatório (LAN) (%VO2pico= 60 ± 8). Amostras de sangue foram coletadas antes, imediatamente após o exercício, 30 e 60 minutos após o exercício, e amostras de urina foram coletadas antes, 30, 60 e 90 minutos após o exercício para mensuração da creatinina e albuminúria. A taxa de filtração glomerular foi avaliada a partir da depuração endógena de creatinina (TFGCr-Cl) e estimada a partir da equação CKD-EPI 2009 (eTFG). RESULTADOS: Imediatamente após o exercício, não foram observadas alterações significantes na TFGCr-Cl e eTFG em todos os grupos (p>0,05). Embora ambos os grupos de pacientes com DRC tenham apresentado aumento da albuminúria imediatamente após o exercício, estes aumentos não foram significantes (p> 0,05). Nenhuma alteração na albuminúria foi detectada no grupo controle durante todo o protocolo (p> 0,05). CONCLUSÃO: Os resultados sugerem que uma sessão de exercício com duração de 30 minutos em intensidade moderada não compromete a função renal de pacientes com DRC. Em suma, estes dados suportam a noção de que o treinamento físico pode ser uma ferramenta terapêutica segura no manejo da DRC<br>BACKGROUND: Physical exercise may be an adjunctive therapy for individuals with chronic kidney diseases (CKD) as this pathological condition has been associated with multiple comorbidities including hypertension and diabetes mellitus. However, little is known about the acute effects of exercise on renal function in patients with CKD at different stages. AIM To investigate the acute effects of aerobic exercise on renal function in patients at different stages of non-dialysis CKD. METHODS: Thirty-three subjects were divided into three groups as follows: i) patients in stages 1 and 2 (CKD1-2; n= 11); ii) stages 3 and 4 (CKD3-4; n= 11); iii) healthy individuals (CON; n= 11). Individuals performed 30 minutes of exercise on a treadmill in an intensity corresponding to the ventilatory anaerobic threshold (VAT) (%VO2peak= 60 ± 8). Blood samples were collected before, immediately after exercise, 30 and 60 minutes after exercise and urine samples were collected before, 30, 60 and 90 minutes after exercise for creatinine and albuminuria assessments. Glomerular Filtration Rate (GFR) was estimated using the creatinine clearance (GFRCr-Cl) and estimated using the CKD-EPI 2009 equation (eGFR). RESULTS: Immediately after exercise, GFRCr-Cl and eGFR did not change significantly in all groups (all p > 0.05). Although both groups of CKD patients have shown increased albuminuria immediately after exercise, differences were not significant (p > 0.05). No change in albuminuria was detected in the control group throughout the protocol (p > 0.05). CONCLUSION: The results suggest that a 30-min moderate intensity aerobic exercise bout does not impair renal function in patients with CKD. Thus, these data support the notion that exercise training can be a safe therapeutic tool in the management of CKD
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Cabral, Ana Sofia Rodrigues Melo. "Depuração plasmática de creatinina exógena em cães submetidos a protocolos terapêuticos de quimioterapia." Master's thesis, Universidade de Lisboa. Faculdade de Medicina Veterinária, 2013. http://hdl.handle.net/10400.5/6173.
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Dissertação de Mestrado Integrado em Medicina Veterinária<br>A incidência de lesões oncológicas em animais de companhia tem vindo a aumentar nos últimos anos, devido principalmente a uma maior longevidade dos mesmos. Consequentemente, cada vez mais, animais de companhia são submetidos a protocolos de quimioterapia.
O uso de quimioterapia surge com intuito de induzir a remissão em neoplasias quimiossensíveis, mas também de forma paliativa, apresentando potenciais efeitos secundários nefastos, entre os quais surge a nefrotoxicidade.
O rim é um órgão fundamental, no que toca à eliminação de xenobióticos. Esta eliminação pode acontecer por filtração glomerular, secreção, reabsorção e metabolização a nível tubular. Assim, compreende-se que, ligeiras e discretas alterações em qualquer uma das suas funções possam ter um papel relevante, no que toca à farmacocinética dos fármacos com eliminação/metabolização renal.
A função renal deve ser sempre avaliada, previamente à realização de um protocolo quimioterápico, de modo a condicionar as doses, duração e escolha do fármaco ou mesmo a sua realização. Em Medicina Veterinária, esta avaliação é feita, na grande maioria das vezes, através da medição da concentração de ureia e creatinina séricas e densidade urinária. No entanto, estes parâmetros apenas se encontram alterados quando há perda de pelo menos 65-75% da massa renal funcional.
Por outro lado, estudos em Medicina Humana evidenciam um aumento acentuado na prevalência de insuficiência renal em pacientes oncológicos sendo que, o seu diagnóstico precoce é cada vez mais importante para a instituição de uma terapêutica adequada de forma a diminuir a sua progressão. Este diagnóstico pode ser feito, através da avaliação da taxa de filtração glomerular (TFG), pela depuração de um marcador de filtração, sendo considerado hoje, tanto em Medicina Humana como em veterinária, o método mais preciso na avaliação da função renal.
Com este projeto, pretende-se avaliar a função renal através da determinação da TFG através da depuração plasmática de creatinina exógena em cães submetidos a protocolos quimioterápicos. Foi escolhido este método uma vez que oferece resultados precisos, é pouco dispendioso, rápido e conveniente de medir na clínica de rotina do hospital escolar da FMV.<br>ABSTRACT - As pets live longer the incidence of oncological diseases have been increased in the last years. Consequently our pets are more and more submitted to chemotherapy protocols.
The use of chemotherapy came to lead the mitigation of chemosensible neoplasias, but also in a palliatve way, presenting potential secondary effects, among them, the nephrotoxity.
The kidney is a fundamental organ because it eliminates xenobiotics and this elimination can occur by glomerular filtration, secretion, reabsortion and tubular metabolization. So we can understand that light and discreet alterations in each of its functions can have a relevant role in the field of pharmacocinetic of the medicines with renal elimination/metabolization.
The renal function must always be evaluated before a chemotherapy protocol takes place, in order to regulate the dose, duration and choose of the medicine or even its realization. In veterinary medicine, in the great majority, this evaluation is done through the measurement of the BUN and serum creatinine concentration and also the urinary density. However these parameters are only modified when there is a loss of, at least, 65-75% of the functional renal mass.
Otherwise, studies in human medicine shows a great increase in the predominance of the renal insufficiency in oncologic patients, but a premature diagnostic is more and more important for the use of an suitable therapy in order to reduce its advance.
This diagnostic can be done through the evaluation of the glomerular filtration rate (GFR), through the clearance of a filtration marker, and it is now considered, not only in human but also in veterinary medicine, as the most precise evaluation of the renal function.
With this project, we intend to evaluate the renal function through the determination of GFR through the plasmatic clearance in dogs which are submitted to chemotherapy protocols. This method was chosen because it gives exact results, it is not very expensive, and it is quickly and convenient to measure in the routine clinic of the scholar hospital of FMW.
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Dehmer, Susanne. "Validation of Abbott Diagnostics turbidimetric cystatin C assay and enzymatic creatinine assay using the Architect c8000 analyzer." Thesis, Uppsala University, Department of Medical Biochemistry and Microbiology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-105609.
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<p><strong>Objective</strong><em>:</em> Estimation of glomerular filtration rate (GFR) is an important tool in the diagnosis and management of chronic kidney disease. Today creatinine is the most frequently used marker for kidney function though several studies indicate that cystatin C is a superior marker. The purpose of this study was to validate Abbott Diagnostics turbidimetric cystatin C assay and enzymatic creatinine assay.</p><p><strong>Methods</strong><em>:</em> The validation was performed by studies of CV for the two methods and correlations between the two and other available methods for assessing GFR. The stability of cystatin C at room temperature was also evaluated.</p><p><strong>Results</strong><em>: </em>Both methods showed good precision. The Abbott cystatin C assay generally gave lower values and thereby higher estimated GFRs than the correlated Gentian method. The Abbott enzymatic creatinine assay gave higher values than the correlated Jaffe method. Those results are generally unexpected, but in this study the cause is an automatically applied negative intercept used together with the Jaffe method. Cystatin C showed high stability when stored at room temperature.</p><p><strong>Conclusions</strong><em>:</em> Estimated GFRs tend to differ depending on the choice of method for analyzing cystatin C or creatinine and this study gives an overview of the range of variation. The study also enlightens the need for an international calibrator for the cystatin C methods presented by different manufacturers.</p>
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Englund, Märta. "Long-term outcome of renal transplantation in childhood /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-394-5/.
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Dhaun, Neeraj. "Endothelin system & its antagonism in chronic kidney disease." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/6528.
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Since its discovery in 1988 the powerful vasoconstrictor endothelin-1 (ET-1) has been widely implicated in the pathophysiology of chronic kidney disease (CKD) as well as the cardiovascular disease with which it is associated. ET receptor antagonists have favourable effects in experimental models of these conditions and orally acting antagonists are now licensed for the treatment of pulmonary arterial hypertension. However, there is a paucity of human data regarding the role of ET-1 in CKD. In this thesis, I have therefore explored the utility of ET-1 as a biomarker in CKD, and, using selective ET receptor antagonists, the beneficial renal and cardiovascular effects of ET receptor antagonism in CKD. I have shown that as glomerular filtration rate (GFR) declines plasma ET-1 increases linearly whereas urinary ET-1 shows an exponential increase. Furthermore, urinary ET-1 may be a useful marker of disease activity in patients with lupus nephritis. Its levels are high in those with biopsy-proven active renal inflammation and these fall with treatment. I have shown that in subjects with stable non-diabetic proteinuric CKD, acute selective ETA receptor antagonism reduces blood pressure and arterial stiffness and that these systemic benefits are associated with an increase in renal blood flow and reduction in proteinuria. Importantly, these effects are seen on top of those achieved with maximal therapy with angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers. Following a study confirming unchanged pharmacokinetics in CKD, I have used an oral selective ETA receptor antagonist to show that the reductions in BP, arterial stiffness and proteinuria seen in my acute studies are maintained longer term. This results of this study also suggest that the mechanism for the reduction in proteinuria is haemodynamic and relates to a reduction in GFR and filtration fraction. In summary, these studies suggest that ET-1 may act as a potential biomarker of renal inflammation, and confirm its role in the pathophysiology of the systemic and renal vasoconstriction seen in CKD. They also suggest that selective ETA receptor antagonism may provide a novel therapeutic approach in proteinuric CKD on top of standard therapies. Larger and longer term studies are now warranted to confirm this potential.
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Salmon, Gandonniere Charlotte. "Iohexol et fonction rénale en réanimation : contribution diagnostique et toxicité." Thesis, Tours, 2018. http://www.theses.fr/2018TOUR3311/document.
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En réanimation, il n’existe pas de gold standard pour estimer le débit de filtration glomérulaire (DFG). Nous avons mesuré la clairance du iohexol chez 20 patients en insuffisance circulatoire aiguë (injection de 5 mL de iohexol et cinétique riche sur 24h). Les clairances urinaire et plasmatique étaient équivalentes ; la clairance plasmatique n’était pas influencée par le remplissage. Nous avons étudié la distribution de la clairance du iohexol chez 85 patients en insuffisance circulatoire aiguë. Quarante-et-un patients (48%) avaient un DFG < 30 mL.min-1, 29 (34%) entre 30 et 60mL.min-1, 10 (12%) entre 60 et 90mL.min-1, 4 (5%) entre 90 et 130 mL.min-1 et 1 (1%) > 130 mL.min-1. Nous avons mesuré les biomarqueurs lésionnels [TIMP-2].[IGFBP-7] juste avant, 6h et 24 h après un scanner injecté en réanimation; il n’y a pas eu d’augmentation significative des biomarqueurs, confortant l’hypothèse d’une toxicité négligeable des produits de contraste iodés en réanimation. En conclusion, le iohexol peut être considéré comme un gold standard pour l’estimation du DFG chez des patients en insuffisance circulatoire aiguë en termes de faisabilité, fiabilité et sécurité<br>There is no gold standard for glomerular filtration rate (GFR) estimation in intensive care unit. We measured iohexol clearance in 20 patients experiencing acute circulatory failure (5 mL iohexol bolus, urine and blood-sample collections over 24h). Urinary and plasma clearances were equivalent; rapid fluid infusion did not influence plasma clearance. We studied iohexol clearance repartition in 85 patients experiencing acute circulatory failure. Forty-one (48%) had a GFR < 30 mL.min-1, 29 (34%) between 30 and 60mL.min-1, 10 (12%) between 60 and 90mL.min-1, 4 (5%) between 90 and 130 mL.min-1 and 1 (1%) > 130 mL.min-1. We measured lesion biomarkers [TIMP-2].[IGFBP-7], before, 6h and 24h after an injected computed tomography scan; there was no significant raise in the biomarkers. This result supports the hypothesis that contrast media are armless in intensive care units. To conclude, iohexol can be considered as a gold standard for GFR estimation in acute-circulatory-failure patients regarding feasibility, reliability and safety
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Chiou, Cheng Suh. "Associação entre aterosclerose subclínica e função renal na população do ELSA-Brasil." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5169/tde-09112017-115459/.
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A doença renal crônica (DRC) é um problema de saúde pública mundial. Além de ser reconhecida como um ônus econômico significativo para a sociedade, está associada a altas taxas de morbidade e mortalidade. Assim, para as políticas de saúde pública, é de suma importância a detecção precoce dos seus fatores de risco relacionados aos desfechos desfavoráveis. As doenças cardiovasculares (DCV) já são reconhecidas por sua influência no desfecho da doença renal, mas a relação da calcificação coronariana (CAC) e DRC na fase inicial ainda é controversa. Nosso objetivo é avaliar se há uma associação independente entre a função renal e a CAC em um estudo transversal de coorte brasileira. Métodos: Os participantes do estudo ELSA-Brasil (N=4189) que realizaram exame de CAC foram categorizados em três grupos de taxa de filtração glomerular estimada (TFGe): G1, no estágio 1 (40,2% de participação), G2, no estágio 2 (55,7%), e G3, do estágio 3 ao 5 (4,1%). Também foram classificados em três níveis, de acordo com a razão albumina/creatinina urinária (RAC): A1, com RAC < 30 mg/g (95,6% de participação), A2, com RAC 30-300 mg/g (4%), e A3, com RAC > 300 mg/g (0,4%). A análise da associação entre CAC e os dois marcadores da DRC (TFGe e RAC) foi realizada por meio do método de regressão logística. Resultados: A regressão logística univariada demonstrou que a redução da TFGe apresentou forte relação com a presença de CAC. O risco relativo de CAC em comparação ao G1 foi de 1,94 (IC 95%, 1,67-2,24) para G2 e de 4,51 (IC 95%, 3,29-6,19) para G3. Entretanto, após o ajuste de idade e de outros fatores de riscos cardiovasculares, essa correlação foi atenuada completamente. Em relação à RAC, o grupo RAC > 300 mg/g apresentou associação positiva e a chance de CAC aumentou para 320%, comparada aos indivíduos sem albuminúria. Conclusão: O presente estudo demonstrou que o risco de calcificação coronariana aumenta precocemente na fase inicial da DRC. As maiores chances de calcificação foram detectadas em participantes com albuminúria > 300 mg/g, independentemente dos fatores de riscos tradicionais e idade. O exame de albuminuria pode refletir presença de calcificação coronariana em indivíduos assintomáticos<br>Chronic kidney disease (CKD) is a worldwide public health problem. As well as being recognized as posing a significant economic burden to society, it is also associated with high morbidity and mortality rates. Thus, early detection of its risk factors associated with unfavorable outcomes is of paramount importance for public health policy. The influence of cardiovascular diseases (CVD) on the outcome of renal disease has been recognized, but the relationship of coronary calcification (CAC) and CKD in the initial phase remains controversial. Our objective is to evaluate whether there is an independent association between renal function and coronary calcification in a cross-sectional Brazilian cohort. Methods: Participants in the ELSA-Brazil Study (N = 4189) who underwent CAC testing were categorized into three groups of estimated glomerular filtration rate (GFR): G1, stage 1 (40.2% of participants), G2, stage 2 (55.7 %) and G3, stages 3 to 5 (4.1%). They were also classified into three levels according to the urinary albumin / creatinine ratio (ACR): A1 ACR < 30 mg/g (95.6% of participants), A2, ACR 30-300 mg/g (4%) and A3, ACR > 300 mg/g (0.4%). Analysis of the association between CAC and the two markers of CKD (GFR and ACR) was performed using the logistic regression method. Results: Univariate logistic regression showed that reduction of eGFR was strongly associated with the presence of CAC. The relative risk of CAC compared to G1 was 1.94 (95% CI, 1.67-2.24) for G2 and 4.51 (95% CI, 3.29-6.19) for G3. However, after adjusting for age and other cardiovascular risk factors, this association was completely attenuated. As for the ACR, the group with ACR > 300 mg/g showed a positive association and the chance of CAC increased to 320%, compared to those without albuminuria. Conclusion: This study demonstrated that the risk of coronary calcification increases early in the initial phase of CKD. A higher chance of calcification was detected in participants with albuminuria > 300 mg/g, irrespective of traditional risk factors or age. Testing for albuminuria could reflect the presence of coronary calcification in asymptomatic individuals
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Brito, Dyego José de Araújo. "Associação entre aterosclerose e marcadores de lesão renal em afrodescendentes hipertensos de comunidades remanescentes de quilombo no norte do Maranhão." Universidade Federal do Maranhão, 2016. http://tedebc.ufma.br:8080/jspui/handle/tede/580.
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Previous issue date: 2016-03-21<br>BACKGROUND: Atherosclerotic lesions are highly prevalent among afrodescendants leading to increased morbidity and mortality from cardiovascular events. Thus, the aim of this study was to investigate the association between atherosclerosis and kidney injury markers in hypertensive afrodescendants from quilombo remnants communities in northern of Maranhão. METHODS: Cross-sectional study that assessed hypertensive afrodescendants from PREVRENAL cohort underwent two different imaging methods for diagnosis of atherosclerosis disease: 1- Carotid doppler ultrasonography (doppler US) to assess the intima-media thickness (cIMT) and/or 2- Coronary computed tomography for determination calcium score (CCS). The kidney damage markers evaluated were 1- estimated glomerular filtration rate (eGFR) and; 2- albuminuria. Information about clinical, laboratory and imaging data were collected in PREVRENAL study database. To evaluate factors associated with the occurrence of coronary and carotid atherosclerosis was adjusted Poisson model with robust variance. The significance level was 5%. Statistical analysis was performed using Stata 12.0 software. RESULTS: Two hundred-six patients (mean age 61.32±12.44 years and 61.65% women) underwent carotid doppler US and 155 patients (mean age 61.42±12.42 years and 62.58% women) underwent coronary CT were included in the study. cIMT presented high in 59.22% individuals evaluated and 41.94% of patients had CCS> 0. In the multivariate regression model, age ≥60 years (PR 1.23, p-value = 0.001), ACR> 30mg/g (PR 1.18, p-value = 0.040) and eGFR/CKD-EPI <60mL/min using cystatin C (PR 1.25, p-value = 0.045) were independently associated with carotid atherosclerosis. The model for coronary calcification were associated with CCS: male gender (PR 1.53, p-value = 0.010), age ≥ 60 years (PR 1.78, p-value = 0.001), use of ASA (PR 1.67, p-value = 0.018) and smoking (PR 1.51, p-value = 0.011). CONCLUSION: The occurrence of atherosclerotic lesions was high in this group. Kidney injury markers were associated only with carotid lesions, whereas traditional factors for atherosclerotic disease were associated with coronary lesions. Thus, afrodescendants with similar clinical and epidemiological characteristics should be strictly monitored and treated to reduce the risk of cardiovascular events.<br>INTRODUÇÃO: As lesões ateroscleróticas são altamente prevalentes entre afrodescendentes, determinado o aumento da morbi-mortalidade por eventos cardiovasculares. Desta forma, o objetivo principal deste estudo foi investigar a associação entre doença aterosclerótica e marcadores de lesão renal em afrodescendentes hipertensos residentes em comunidades remanescentes de quilombo no Norte do Maranhão. MÉTODOS: Estudo transversal que avaliou afrodescendentes hipertensos da coorte PREVRENAL, submetidos a dois diferentes métodos de imagem para diagnóstico de doença aterosclerótica: 1- US Doppler de carótidas para avaliação da espessura médio-intimal (EMIC) e 2- Tomografia computadorizada coronariana para determinação do escore de cálcio (ECC). Os marcadores de lesão renal avaliados foram: 1- Taxa de filtração glomerular estimada (TFGe) e 2- Albuminúria. Os dados clínicos, laboratoriais e de imagem foram coletadas no banco de dados do PREVRENAL. Para avaliar os fatores associados à ocorrência de aterosclerose coronariana e carotídea foi ajustado o modelo de Poisson com variância robusta. O nível de significância adotado foi de 5%. A análise estatística foi realizada através do software Stata 12.0. RESULTADOS: Duzentos e seis pacientes (média de idade de 61,32±12,44 anos e 61,65% de mulheres) que realizaram US Doppler de carótidas e 155 pacientes (média de idade de 61,42±12,42anos e 62,58% de mulheres) submetidos à tomografia coronariana foram incluídos no estudo. Apresentaram EMIC elevada 59,22% dos indivíduos avaliados e 41,94% tinham ECC>0. No modelo de regressão ajustada, idade >60 anos (RP 1,23, p-valor=0,001), RAC >30mg/g (RP 1,18, pvalor= 0,040) e TFGe/CKD-EPI <60mL/min utilizando a cistatina C (RP 1,25, pvalor= 0,045) estiveram independentemente associados com aterosclerose carotídea. No modelo para calcificação coronariana, apresentaram associação com ECC: sexo masculino (RP 1,53, p-valor=0,010), idade >60 anos (RP 1,78, p-valor=0,001), uso de AAS (RP 1,67, p-valor=0,018) e tabagismo (RP 1,51, p-valor=0,011). CONCLUSÃO: A ocorrência de lesões ateroscleróticas foi expressiva no grupo estudado. Marcadores de lesão renal foram associados apenas com lesões carotídeas, enquanto que fatores tradicionais para doença aterosclerótica foram associados com as lesões coronarianas. Desta forma, indivíduos afrodescendentes com características clínico-epidemiológicas semelhantes devem ser estritamente monitorizados e tratados para reduzir o risco de ocorrência de eventos cardiovasculares.
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Löwenborg, Eva. "Nephrotic syndrome in children : functional, morphological and therapeutical aspects /." Stockolm, 2003. http://diss.kib.ki.se/2003/91-7349-360-0/.
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Amador, Victoria Araujo Ganzaroli. "Indicadores antropométricos e marcadores de função renal em adultos e idosos." Universidade Federal de Goiás, 2014. http://repositorio.bc.ufg.br/tede/handle/tede/4007.
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Previous issue date: 2014-03-31<br>Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG<br>Weight excess is one of the risk factors of chronic kidney disease, so it is important to evaluate the nutritional status of population with renal function markers to monitor and prevent the increase of renal failure. The aims of this study was to evaluate the association of nutritional status indicators and renal function markers in adults and seniors. It is a cross-sectional study with 279 adults and seniors assisted by eight primary healthcare units from east Goiânia. Data were collected utilizing a standard questionnaire which included sociodemographic, life style and clinical information. Body mass index and waist circumference were taken for nutritional status evaluation; chronic kidney disease was defined as an glomerular filtration rate of less than 60 mL/min/1,73m²; microalbuminury were considerated with albumin/creatinine ratio righer than 30mg/g.Chronic kidney disease was prevalent in 8.9% and microalbuminuria in 34.8%. The prevalence of overweight was 57%. Waist circumference and body mass index had a positive association with the glomerular filtration rate, characterized as glomerular hyperfiltration. Microalbuminuria had a positive association with body mass index in women. There were a high prevalence of chronic kidney disease and overweight in the studied population. The overweight had a positive association with the glomerular filtration rate. Body mass index should be often used as it is a cheap and efficient anthropometric measurement method and is an early detection indicator of renal function in population<br>O excesso de peso é um dos fatores de risco para doença renal crônica e com isso, torna-se importante a avaliação nutricional da população associada à avaliação de marcadores de função renal a fim de monitorar e controlar o aumento da prevalência de insuficiência renal. O objetivo deste trabalho foi avaliar a associação entre indicadores do estado nutricional e marcadores da função renal em adultos e idosos. Trata-se de um estudo transversal realizado com 279 adultos e idosos atendidos por oito Unidades de Atenção Básica à Saúde da Família da Região Leste de Goiânia, por meio de visitas domiciliares. Foram coletados dados socioeconômicos, de estilo de vida e clínicosutilizando-se questionário padronizado. Para avaliação do estado nutricional foi considerado o Índice de Massa Corporal e circunferência da cintura.Para o diagnóstico de doença renal crônica foi considerada uma taxa de filtração glomerular <60 mL/min/1,73m² e para detecção de presença de microalbuminúria foi considerada a relação albumina/creatinina urinária > 30mg/g. A prevalência de doença renal crônica encontrada foi de 8,9%, enquanto que de albuminúria foi de 34,8%. O excesso de peso foi detectado em 57% da população. Houve associação significativa do índice de massa corporal e circunferência da cintura com a taxa de filtração glomerular, caracterizando um quadro de hiperfiltração glomerular. Quanto à albuminúria, a associação foi encontrada somente para o índice de massa corporal aumentado em mulheres. A amostra apresentou alta prevalência de doença renal crônica e excesso de peso, sendo que os indicadores antropométricos apresentaram associação positiva com a taxa de filtração glomerular. Com isso, sugere-se que o índice de massa corporal, um método barato e de fácil aplicabilidade, seja usado como indicador precoce para detecção de alterações na função renal em grupos de risco para doença renal crônica.
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Coelho, Fernanda Oliveira. "Efeitos renais da exposição crônica a nicotina em camundongos com deficiência de Klotho." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5148/tde-09112015-124235/.
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A nicotina é o principal componente do tabaco e dos cigarros eletrônicos. A exposição crônica a nicotina, em quantidades semelhantes às atingidas pelo tabagismo humano, é responsável por piora da lesão renal aguda e da doença renal crônica. O gene klotho, predominantemente expresso no rim, foi descoberto após uma mutação insercional, com o surgimento de um fenótipo semelhante ao envelhecimento humano nos camundongos homozigotos para esse transgene. A proteína Klotho transmembrana tem ação de co-receptor do fator de crescimento fibroblástico 23 (FGF-23) e sua forma secretada atua em diversas vias intracelulares e em órgãos a distância. A deficiência de Klotho ocorre no envelhecimento, em situações que levam a lesão renal aguda e na doença renal crônica. A expressão reduzida de Klotho também agrava lesão renal aguda e participa da progressão da doença renal crônica, enquanto o seu aumento, ou a sua reposição, protegem dos processos inflamatórios e do estresse oxidativo. Neste estudo, objetivamos avaliar os efeitos renais, hemodinâmicos e sobre a expressão de Klotho da exposição crônica a nicotina e quais os efeitos dessa exposição nos animais haploinsuficientes para o transgene klotho (Kl+/-). Utilizamos para estas avaliações camundongos Kl+/- e seus controles wild type (Kl+/+), que foram expostos a nicotina (200 mcg/mL) ou veículo (sacarina 2%) diluídos em água por 28 dias. Ao final do estudo foram avaliados diurese, eletrólitos plasmáticos e urinários, ureia, aldosterona, ADH, FGF-23 e PTH intactos plasmáticos, expressão protéica renal de Klotho, alfa7-nAchR, NHE3, ENaC, NKCC2, AQP2, e-NOS, VEGF, MnSOD e renina, expressão genica renal de klotho, interleucinas, TBARS e GSH em tecido renal, taxa de filtração glomerular por FITC-inulina, pressão arterial e frequência cardíaca invasivas, sensibilidade baroreflexa e modulação autonômica cardíaca e periférica por análise espectral. Após a exposição a nicotina, os animais Kl+/+ apresentaram redução da expressão renal da proteína e do RNAm de Klotho e uma tendência a aumento dos níveis plasmáticos de FGF-23, associados a uma queda da diurese e da taxa de filtração glomerular, sem alteração dos níveis de ADH. Esses animais Kl+/+ também apresentaram aumento da sensibilidade barorreflexa em resposta ao nitroprussiato e um predomínio da modulação simpática cardíaca, com redução da expressão renal dos alfa7-nAchR. Os animais Kl+/- tiveram níveis renais ainda menores de Klotho após a exposição a nicotina, com aumento de TBARS, IL-6, uréia e aldosterona em relação aos Kl+/- não expostos. A diurese, a taxa de filtração glomerular e a expressão dos alfa7-nAchR não se reduziram e não houve aumento da sensibilidade barorreflexa após exposição a nicotina, com um predomínio da modulação parassimpática cardíaca, nesses animais Kl+/-. A ingesta hídrica, a pressão arterial e a frequência cardíaca foram semelhantes entre os 4 grupos. A proteinúria foi maior nos animais Kl+/- do que nos animais Kl+/+ após a exposição a nicotina. Podemos concluir que a exposição crônica à nicotina reduz a expressão renal de Klotho, estimula vias de inflamação, fibrose e estresse oxidativo renais e tem efeitos renais e sistêmicos diferentes de acordo com os níveis basais de Klotho<br>Nicotine is a major compound of tobacco and electronic cigarettes. Chronic exposure to nicotine concentrations that are similar to human smoke worsens acute kidney injury and chronic kidney disease. The klotho (Kl) gene is expressed predominantly by the kidney and was discovered after an unintentional insertional mutation that resulted, in transgenic homozygous mice, in a phenotype similar to human aging. Klotho transmembrane protein acts as a co-receptor to fibroblastic growth factor 23 (FGF-23) and the secreted form interacts in multiple intracellular pathways, with effects in distant organs. Klotho deficiency occurs in aging and in multiple acute kidney injury and chronic kidney disease etiologies, whereas klotho upregulation and replacement protect from inflammation and oxidative stress. Here, we investigated renal and hemodynamic effects of chronic nicotine exposure, its effects over renal expression of Kl, and compared wild type (Kl+/+) and Kl haploinsufficient mice (Kl+/-) in terms of the effects of that exposure. Kl+/- and Kl+/+ mice received nicotine (200 ?g/ml) or vehicle (saccharine 2%) in drinking water for 28 days. We evaluated diuresis, ions in serum and urine, urea, plasma and urinary levels of cotinine, aldosterone, plasma antidiuretic and parathyroid hormone, plasma FGF-23, protein expression of (immunoblotting for) Klotho and ?7 nicotinic acetylcholine receptor, NHE3, NKCC2, ENaC, aquaporin-2, e-NOS, VEGF and renin, klotho mRNA, kidney interleukines, TBARS and GSH, glomerular filtration rate by fluorescein isothiocyanate-inulin clearance, mean arterial pressure, heart rate, baroreflex sensitivity and autonomic cardiac and peripheral modulation by spectral analysis. After nicotine exposure, Kl+/+ mice showed decreased Klotho protein and mRNA and a tendency towards an elevation in plasma FGF-23, which were associated with both diuresis and glomerular filtration rate reductions, without modifications in ADH levels. Besides that, Kl+/+ animals increased baroreflex sensitivity after nitroprusside, a predominant sympathetic cardiac modulation and lower alfa7-nAchR kidney expression. Kl+/- mice reduced even more Klotho renal expression, with higher levels of TBARS, IL-6, urea and aldosterone. Diuresis, glomerular filtration rate, alfa7-nAchR expression and baroreflex sensitivity were the same of their controls. Cardiac parasympathetic modulation predominated in Kl+/- mice. Fluid intake, mean arterial pressure and heart rate were similar across the 4 groups. Renal protein excretion was higher in Kl+/- than in their controls after nicotine exposure. We can conclude that chronic nicotine exposure downregulates Klotho kidney expression induces inflammation and oxidative stress and stimulates fibrosis, with different renal and systemic responses according to basal Klotho levels