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Renal Function (renal + function)
Kinds of Renal Function Selected AbstractsVolume Overload and Renal Function of Congestive Heart Failure: CMECONGESTIVE HEART FAILURE, Issue 2010Article first published online: 23 JUL 2010 No abstract is available for this article. [source] Copeptin: A Biomarker of Cardiovascular and Renal FunctionCONGESTIVE HEART FAILURE, Issue 2010Nils G. Morgenthaler MD Congest Heart Fail. 2010;16(4)(suppl 1):S37,S44. ©2010 Wiley Periodicals, Inc. Arginine vasopressin (AVP or antidiuretic hormone) is one of the key hormones in the human body responsible for a variety of cardiovascular and renal functions. It has so far escaped introduction into the routine clinical laboratory due to technical difficulties and preanalytical errors. Copeptin, the C-terminal part of the AVP precursor peptide, was found to be a stable and sensitive surrogate marker for AVP release. Copeptin behaves in a similar manner to mature AVP in the circulation, with respect to osmotic stimuli and hypotension. During the past years, copeptin measurement has been shown to be of interest in a variety of clinical indications, including cardiovascular diseases such as heart failure, myocardial infarction, and stroke. This review summarizes the recent progress on the diagnostic use of copeptin in cardiovascular and renal diseases and discusses the potential use of copeptin measurement in the context of therapeutic interventions with vasopressin receptor antagonists. [source] Effects of Norepinephrine and Combined Norepinephrine and Fenoldopam Infusion on Systemic Hemodynamics and Indices of Renal Function in Normotensive Neonatal FoalsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2008A.R. Hollis Background: Norepinephrine increases arterial blood pressure but may have adverse effects on renal blood flow. Fenoldopam, a dopamine-1 receptor agonist, increases urine output in normotensive foals. The combination of norepinephrine and fenoldopam may lead to improved renal perfusion compared with an infusion of norepinephrine alone. The combined effects of these drugs have not been reported in the horse. Hypothesis: Norepinephrine will alter the hemodynamic profile of foals without affecting renal function. Addition of fenoldopam will change the renal profile during the infusions without changing the hemodynamic profile. Animals: Five conscious pony foals. Methods: Each foal received norepinephrine (0.3 ,g/kg/min), combined norepinephrine (0.3 ,g/kg/min) and fenoldopam (0.04 ,g/kg/min), and a control dose of saline in a masked, placebo-controlled study. Heart rate (HR), arterial blood pressure (direct), and cardiac output (lithium dilution) were measured, and systemic vascular resistance (SVR), stroke volume, cardiac index (CI), and stroke volume index were calculated. Urine output, creatinine clearance, and fractional excretion of electrolytes were measured. Results: Norepinephrine and a combined norepinephrine and fenoldopam infusion increased arterial blood pressure, SVR, urine output, and creatinine clearance and decreased HR and CI compared with saline. The combination resulted in higher HR and lower arterial blood pressure than norepinephrine alone. Conclusions and Clinical Importance: Norepinephrine might be useful for hypotensive foals, because in normal foals, this infusion rate increases SVR without negatively affecting renal function (creatinine clearance increased). Fenoldopam does not provide additional benefit to renal function. These findings warrant further investigation. [source] Impact of Renal Function on Survival in Patients with Implantable Cardioverter-DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007MINTU P. TURAKHIA M.D. Background:Although chronic renal insufficiency (CRI) is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between CRI and survival in patients with implantable cardioverter-defibrillators (ICDs), particularly across a wide range of renal function. Methods:We studied 507 consecutive patients receiving first-time ICDs from 1993,2003 at a single center. Preimplant serum creatinine measurements were used to determine glomerular filtration rate (GFR) and stage of chronic kidney disease (CKD). The primary outcome was time to death. Results:During a mean follow-up of 4 years, all-cause mortality through completion of follow-up increased stepwise by GFR stage (I: 16%, II: 20%, III: 35%; IV: 40%; V: 50%; P < 0.001 for trend). After multivariate adjustment, CRI was independently associated with death (HR = 1.7, P = 0.02), as were a serum creatinine ,2.0 mg/dL (HR 2.5, P = 0.003) and the presence of end-stage renal disease (HR 6.8; P < 0.001). For every 10-unit decrease in GFR, the adjusted hazard of death increased 12% (P = 0.04). Conclusion:The presence of CRI prior to implant is independently associated with increased mortality in patients receiving ICDs. The risk is proportional to the degree of renal dysfunction and is apparent even when GFR is only mildly reduced. Differences in mortality are observed within the first year of implant, and patients on dialysis are at highest risk. Because randomized trials of ICDs have not included large numbers of patients with moderate or severe renal disease, our findings may have important implications in prognosis and case selection of patients who otherwise meet current indications for ICD implantation. [source] Early Withdrawal of Calcineurin Inhibitors and Everolimus Monotherapy in de novo Liver Transplant Recipients Preserves Renal FunctionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010M. Masetti We designed a randomized trial to assess whether the early withdrawal of cyclosporine (CsA) followed by the initiation of everolimus (Evr) monotherapy in de novo liver transplantation (LT) patients would result in superior renal function compared to a CsA-based immunosuppression protocol. All patients were treated with CsA for the first 10 days and then randomized to receive Evr in combination with CsA up to day 30, then either continued on Evr monotherapy (Evr group) or maintained on CsA with/without mycophenolate mofetil (CsA group) in case of chronic kidney disease (CKD). Seventy-eight patients were randomized (Evr n = 52; CsA n = 26). The 1-year freedom from efficacy failure in Evr group was 75% versus 69.2% in CsA group, p = 0.36. There was no statistically significant difference in patient survival between the two groups. Mean modification of diet in renal disease (MDRD) was significantly better in the Evr group at 12 months (87.7 ± 26.1 vs. 59.9 ± 12.6 mL/min; p < 0.001). The incidence of CKD stage ,3 (estimated glomerular filtration rate <60 mL/min) was higher in the CsA group at 1 year (52.2% vs. 15.4%, p = 0.005). The results indicate that early withdrawal of CsA followed by Evr monotherapy in de novo LT patients is associated with an improvement in renal function, with a similar incidence of rejection and major complications. [source] Rapid Decline in 51Cr-EDTA Measured Renal Function During the First Weeks Following Lung TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2009M. Hornum We previously described a 54% decline in renal function at 6 months after lung transplantation (LTx). We hypothesized that this decline is a very early event following LTx. Thirty-one consecutive patients (16 females/15 males), mean age 49 (±13) years, with emphysema, cystic fibrosis/bronchiectasis or idiopathic pulmonary fibrosis were included in an analysis of renal function before and after LTx. The glomerular filtration rate (GFR) was measured using the 51Cr-ethylenediaminetetra acetic acid plasma clearance single injection technique (mGFR) at baseline before transplantation and at 1, 2, 3 and 12 weeks postoperatively. Mean mGFR declined from 103 ± 18 to 65 ± 22, 53 ± 16 and 57 ± 18 mL/min/1.73m2 at 1-, 3- and 12-weeks post-LTx (p < 0.0001), respectively. In a time-dependent repeated measures ANOVA, risk factors for a decline in mGFR posttransplant included: time (p < 0.0001), acute renal failure within 2 weeks post-LTx (p = 0.0003), use of heart and lung machine (p = 0.04), and the use of ephedrine (p = 0.048), as well as increasing age, older than 18 years at LTx (p = 0.006). These data demonstrate that renal function, measured with an isotope method, decreases dramatically during the first week after LTx. [source] Efficacy on Renal Function of Early Conversion from Cyclosporine to Sirolimus 3 Months After Renal Transplantation: Concept StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009Y. Lebranchu Sirolimus (SRL) allows to minimize the use of cyclosporine (CsA), but de novo administration after transplantation is associated with various complications. We report a prospective, open-label, multicenter randomized study to evaluate conversion from a CsA-based regimen to a SRL-based regimen 3 months after transplantation. One hundred ninety-two of a total of 237 patients were eligible at 3 months to be converted to SRL (n = 95) or to continue CsA (n = 97). All patients were also given mycophenolate mofetil (MMF) and oral steroids, planned to be discontinued at month 8. The primary endpoint, the clearance estimated according to Cockcroft and Gault at week 52, was significantly better in the SRL group (68.9 vs. 64.4 mL/min, p = 0.017). Patient and graft survival were not statistically different. The incidence of acute rejection episodes, mainly occurring after withdrawal of steroids, was numerically but not statistically higher in the SRL group (17% vs. 8%, p = 0.071). Sixteen patients discontinued SRL, mainly for adverse events (n = 11), and seven patients discontinued CsA for renal failure or acute rejection. Significantly, more patients in the SRL group reported aphthous, diarrhea, acne and high triglyceride levels. Conversion CsA to SRL 3 months after transplantation combined with MMF is associated with improvement in renal function. [source] Valganciclovir Dosing According to Body Surface Area and Renal Function in Pediatric Solid Organ Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009W. Vaudry Oral valganciclovir is effective prophylaxis for cytomegalovirus (CMV) disease in adults receiving solid organ transplantation (SOT). However, data in pediatrics are limited. This study evaluated the pharmacokinetics and safety of valganciclovir oral solution or tablets in 63 pediatric SOT recipients at risk of CMV disease, including 17 recipients ,2 years old. Patients received up to 100 days' valganciclovir prophylaxis; dosage was calculated using the algorithm: dose (mg) = 7 × body surface area × creatinine clearance (Schwartz method; CrCLS). Ganciclovir pharmacokinetics were described using a population pharmacokinetic approach. Safety endpoints were measured up to week 26. Mean estimated ganciclovir exposures showed no clear relationship to either body size or renal function, indicating that the dosing algorithm adequately accounted for both these variables. Mean ganciclovir exposures, across age groups and organ recipient groups were: kidney 51.8 ± 11.9 ,g * h/mL; liver 61.7 ± 29.5 ,g * h/mL; heart 58.0 ± 21.8 ,g * h/mL. Treatment was well tolerated, with a safety profile similar to that in adults. Seven serious treatment-related adverse events (AEs) occurred in five patients. Two patients had CMV viremia during treatment but none experienced CMV disease. In conclusion, a valganciclovir-dosing algorithm that adjusted for body surface area and renal function provides ganciclovir exposures similar to those established as safe and effective in adults [source] Delayed Introduction of Reduced-Dose Tacrolimus, and Renal Function in Liver Transplantation: The ,ReSpECT' StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009J. M. Neuberger We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult patients with good renal function undergoing primary liver transplant were randomized to either: group A (standard-dose tacrolimus [target trough levels >10 ng/mL] and corticosteroids; n = 183); group B (mycophenolate mofetil [MMF] 2g/day, reduced-dose tacrolimus [target trough levels ,8 ng/mL], and corticosteroids; n = 170); group C (daclizumab induction, MMF, reduced-dose tacrolimus delayed until the fifth day posttransplant and corticosteroids, n = 172). The primary endpoint was change from baseline in estimated glomerular filtration rate (eGFR) at 52 weeks. The eGFR decreased by 23.61, 21.22 and 13.63 mL/min in groups A, B and C, respectively (A vs C, p = 0.012; A vs B, p = 0.199). Renal dialysis was required less frequently in group C versus group A (4.2% vs. 9.9%; p = 0.037). Biopsy-proven acute rejection rates were 27.6%, 29.2% and 19.0%, respectively. Patient and graft survival was similar. In conclusion, daclizumab induction, MMF, corticosteroids and delayed reduced-dose tacrolimus was associated with less nephrotoxicity than therapy with standard-dose tacrolimus and corticosteroids without compromising efficacy or tolerability. [source] The Impact of Aprotinin on Renal Function After Liver Transplantation: An Analysis of 1043 PatientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2007N. Warnaar Renal dysfunction is frequently seen after orthotopic liver transplantation (OLT). Aprotinin is an antifibrinolytic drug which reduces blood loss during OLT. Recent studies in cardiac surgery suggested a higher risk of postoperative renal complications when aprotinin is used. The impact of aprotinin on renal function after OLT, however, is unknown. In 1043 adults undergoing OLT, we compared postoperative renal function in patients who received aprotinin (n = 653) or not (n = 390). Using propensity score stratification (C-index 0.82) and multivariate regression analysis, aprotinin was identified as a risk factor for severe renal dysfunction within the first week, defined as increase in serum creatinine by , 100% (OR = 1.97, 95% CI = 1.14,3.39; p = 0.02). No differences in renal function were noted at 30 and 365 days postoperatively. Moreover, no significant differences were found in the need for renal replacement therapy (OR = 1.52, 95% CI = 0.94,2.46; p = 0.11) or in 1-year patient survival rate (OR = 1.14, 95% CI = 0.73,1.77; p = 0.64) in patients who received aprotinin or not. In conclusion, aprotinin is associated with a higher risk of transient renal dysfunction in the first week after OLT, but not with a higher need for postoperative renal replacement therapy or an increased risk of mortality. [source] Pre-Transplant IFN-, ELISPOTs Are Associated with Post-Transplant Renal Function in African American Renal Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2005Joshua J. Augustine Final crossmatch testing is routinely used to assess the risk of antibody-mediated graft injury/rejection post-transplant. Analogously, we postulated that quantitative measurements of anti-donor effector/memory T cells pre-transplant would independently assess post-transplant risk. To address this hypothesis, we determined the frequencies of pre-transplant, donor-specific interferon-, (IFN-,) enzyme-linked immunosorbent spots (ELISPOTs) and correlated the results with post-transplant outcomes in 37 African American recipients of deceased donor kidney transplants treated with tacrolimus- and sirolimus-based immunosuppression. A positive ELISPOT test (>25 spots/300 000 cells) was detected in 14 (38%) of 37 patients. The incidence of biopsy-proven acute rejection was 50% (7/14) in ELISPOT-positive versus 17% (4/23) in ELISPOT-negative patients (p = 0.036). Calculated glomerular filtration rate (MDRD) at 12 months was 37 ± 16 mL/min in ELISPOT-positive versus 55 ± 20 mL/min in ELISPOT-negative patients (p = 0.01). ELISPOT status remained a correlate of allograft function at 12 months by linear regression analysis (p = 0.001), independent of rejection and other contributing variables. Pre-transplant donor-directed IFN-, ELISPOT assessment of anti-donor cellular immunity may function as a ,cellular crossmatch' and independently correlates with renal allograft function in African Americans receiving tacrolimus- and sirolimus-based immunosuppression. [source] Assessing Renal Function by GFR Prediction Equations in Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2005Norberto Perico No abstract is available for this article. [source] The Effects of Angiotensin Converting Enzyme Inhibitors on Potassium Homeostasis in Dialysis Patients With and Without Residual Renal FunctionARTIFICIAL ORGANS, Issue 8 2009Elizabeth Garthwaite Abstract Hyperkalemia is exacerbated by angiotensin converting enzyme inhibitors (ACE-I). Distal potassium (K+) secretion is negligible in anuric patients. ACE-I therapy may reduce renal, peritoneal, and colonic K+ losses. We examined the effect of ACE-I therapy on serum, urinary, and dialysate K+ in a cross-section of peritoneal and hemodialysis patients. Serum, 24-h urine K+, and peritoneal dialysate excretion K+ levels were measured and the results were compared in the various dialysis and treatment groups. Eighty-one hemodialysis (HD) and 32 peritoneal dialysis (PD) patients were included. Serum K+ in HD patients with no residual renal function (RRF) was higher in those receiving ACE-I therapy (P = 0.02). Serum K+ levels in HD patients receiving ACE-I treatments with RRF was similar to that in oligoanuric HD patients not receiving an ACE-I. Urinary K+ excretion was significantly reduced in those on ACE-I therapy versus those not on an ACE-I (P < 0.05). Mean serum K+ was lower in PD versus HD patients (P < 0.05). PD patients with no RRF on ACE-I therapy had higher serum K+ concentrations (P = 0.002) and dialysate K+ excretion was lower (P = 0.05), in comparison with PD patients not on an ACE-I. PD patients with RRF on ACE-I therapy had higher serum K+ concentrations compared with those not on ACE-I therapy (P = 0.03). Both urinary and dialysate K+ excretion were reduced (P = 0.001 and P = 0.002, respectively). ACE-I therapy increases serum K+ concentration in dialysis patients. PD patients have relatively lower serum K+ levels compared with HD patients. In PD patients, ACE-I therapy reduces dialysate K+. These changes may result from reduced peritoneal movement of K+. [source] 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors prevent the progression of renal dysfunction in Japanese hypertensive patientsGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2010Masanori Kuwabara Aim: The aim was to determine whether the use of statins prevents the progression of chronic kidney disease (CKD) in hypertensive patients. Methods: We retrospectively reviewed data obtained from hypertensive patients, and subjects with diabetes mellitus and those undergoing hemodialysis were excluded. At total of 227 patients were enrolled (83 men, mean age 73 years) and 90% of the patients were of CKD stage 2 or 3. The patients were divided into two groups: those treated with statins (n = 93) and those not treated with statins (n = 134). Renal function was evaluated by estimated glomerular filtration rate (eGFR). Results: The statin group and the non-statin group were similar in age, sex, blood pressure, follow-up period and prescriptions of antihypertensive medicines. The eGFR in the statin group increased from 62 ± 14 to 66 ± 15 (mL/min per 1.73 m2), whereas it decreased in the non-statin group from 69 ± 16 to 64 ± 18 (mL/min per 1.73 m2). The annual eGFR improved in the statin group (2.5 ± 6.6 mL/min per 1.73 m2/year), but decreased in the non-statin group (,3.3 ± 6.6 mL/min per 1.73 m2/year) (P < 0.001). When the patients were divided into two groups by low-density lipoprotein (LDL) cholesterol levels at the second evaluation, annual eGFR improved in the group of LDL to below 100 mg/dL (n = 99) (0.4 ± 7.2 mL/min per 1.73 m2/year), but decreased in the other group (n = 128) (,1.9 ± 7.0 mL/min per 1.73 m2/year) (P = 0.018). Conclusion: Lipid-lowering intervention with statins inhibits the progression of CKD in hypertensive patients. Geriatr Gerontol Int 2010; 10: 219,224. [source] Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2004Natividade Rocha MD A 28-year-old woman, employed as a leather factory worker, noted asymptomatic, well-delimited plaques on both knees, 6 years ago. The plaques were violaceous with a smooth surface. One appeared over a post-traumatic scar from childhood (Fig. 1). Two years later, she began to complain of symptoms suggestive of polyarthritis, first of the small joints of the hands (proximal interphalanges) and then of the larger joints (wrists, elbows, and knees). She was diagnosed with rheumatoid arthritis and began treatment with nonsteroidal anti-inflammatory drugs for 1 month without any change. Deflazacort, 12 mg/day, and hydroxychloroquine, 400 mg/day, were administered for 3 months, with improvement of her articular complaints, but not her skin lesions. Figure 1. Well-delimited, violaceous plaques with a smooth surface on the knees, one over an old post-traumatic scar One year later, she complained of dysphonia, which remitted spontaneously after some weeks. After one additional year, she noted papules, with similar characteristics to the plaques, on the elbows, and two well-delimited orange-to-brown plaques on the forehead (Fig. 2). Figure 2. Orange,brown plaques symmetrically placed on the forehead During the fifth year of the disease, she was referred for the first time to a dermatologist, who biopsied one of the knee lesions. The histologic result was compatible with "sarcoid granuloma." At that time, she presented with skin lesions as her only complaint. Sarcoidosis was suspected based on a chest X-ray, which revealed hilar lymphadenopathy and diffuse accentuation of the interstitium. In November 2000, she suddenly developed fever (40 °C), cough with hemoptysis, dysphonia, and subcutaneous nodules on the palmar surface of the fingers of both hands that were painless, well-delimited, 5 mm in diameter, and firm (Fig. 3). She reported a weight loss of 12 kg in the previous 3 months. Pulmonary condensation was found on auscultation, and she had palpable hepatomegaly. Peripheral lymphadenopathy was not present. Figure 3. Painless, well-delimited, firm subcutaneous nodules on the palmar surface of the fingers Laboratory investigations revealed normochromic, normocytic anemia (hemoglobin, 7.7 g/dL), iron deficit, a white blood cell count of 16,000/µL with neutrophilia, an erythrocyte sedimentation rate of 130 mm/h, elevation of liver enzymes, a slight increase in angiotensin-converting enzyme (ACE) level (72 U/L), hypergammaglobulinemia (IgG, 3350 mg/dL), antinuclear antibody (ANA) of 1 : 320, and a slight increase in CD4 and decrease in CD8 lymphocytes with normal cellular morphology in blood. Renal function, urine sediment, urine and serum calcium, complement (C4), dsDNA, antimitochondrial antibody, direct and indirect Coombs test, antineutrophil cytoplasmic antibody (ANCA), tuberculin skin tests, viral markers of hepatitis B, C, and human immunodeficiency virus (HIV), electrocardiogram (ECG), ophthalmic examinations, and culture for infectious agents in blood and sputum were all normal or negative. Computed tomography (CT) scan showed an infiltrate in the upper right pulmonary lobule with a central cavity and bilateral hilar lymphadenopathy (Fig. 4). Homogeneous hepatosplenomegaly was present. The bronchoalveolar lavage (BAL) showed a slight lymphocytic increase predominantly of CD8 cells and hemosiderosis. Stains for infectious agents, including acid-fast bacillus, fungi, Mycoplasma, and Legionella, were negative. Three biopsies from the forehead, elbows, and knees showed well-formed noncaseating epithelioid cell granulomas with giant cells of the Langhans type in the dermis, suggestive of sarcoidosis (Figs 5 and 6). A fourth biopsy from a finger nodule demonstrated inflammatory infiltration of the dermis and necrosis with cellular debris. Vasculitis was not seen (Fig. 7). Figure 4. Computed tomography scan showing an infiltrate in the upper right pulmonary lobule with a central cavity Figure 5. Beneath a flattened epidermis, several sarcoid granulomas composed of epithelioid histiocytes and several multinucleated giant cells of Langhans type can be seen (hematoxylin and eosin, ×10) Figure 6. Less well-formed sarcoid granulomas in a hyperkeratotic area, surrounded by a sparse rim of lymphocytes (hematoxylin and eosin, ×20) Figure 7. Foci of necrosis and fibrinoid degeneration with some neutrophil infiltration and nuclear dusting (hematoxylin and eosin, ×40) The patient was treated with a broad-spectrum empirical antimicrobial (levofloxacin, 500 mg daily intravenously) over 12 days, with prompt improvement in her symptoms and remission of the forehead and finger lesions. Nevertheless, on the first evaluation after hospitalization, the CT scan showed persistence of the pulmonary cavity (Fig. 8). A repeat ANCA determination was positive (cytoplasmic pattern, c-ANCA) at 1 : 640 by indirect immunofluorescence (IIF). Antiproteinase-3 antibody was demonstrated at 78 by enzyme-linked immunosorbent assay (ELISA). Figure 8. Computed tomography scan showing persistence of the pulmonary cavity She underwent an open lung biopsy which revealed intra-alveolar hemorrhage and scanty noncaseating epithelioid cell granulomas of the sarcoidosis type in the peripheral blood vessels without vasculitis. A diagnosis of Wegener's granulomatosis was made and she began prednisolone (1 mg/kg/day) and oral cyclophosphamide (2 mg/kg/day). One year later, she is asymptomatic, the skin lesions have completely remitted, c-ANCA is negative, and the CT scan shows partial regression of the pulmonary cavity. [source] Uric Acid as a Marker for Renal Dysfunction in Hypertensive Women on Diuretic and Nondiuretic TherapyJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2009Rodolfo. Hyperuricemia is a common finding in hypertensive patients, especially among those who are on diuretic therapy. However, its clinical relevance regarding cardiovascular and chronic kidney disease (CKD) has not clearly been established. The authors assessed whether, in a population of 385 hypertensive women categorized according to diuretic therapy, the stratification in quartiles by uric acid levels would identify a gradient of changes in renal function and in risk factors for cardiovascular disease. The following were evaluated: serum uric acid, glycemia, total and fractional cholesterol, triglycerides, apolipoprotein (Apo) B, Apo A-I, and C-reactive protein. Renal function was assessed by serum creatinine, albuminuria, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation, whereas cardiovascular risk was estimated through the Framingham score. A total of 246 women were on diuretic therapy; 139 were taking other antihypertensive medications. There was a reduction in eGFR parallel to the increase in uric acid levels, regardless of diuretic use and without a concomitant increase in albuminuria. In both groups, higher uric acid levels translated into an increase in metabolic syndrome components, in markers of insulin resistance, triglyceride/high-density lipoprotein levels, and Apo B/Apo A-I ratios, as well as in Framingham scores. Hyperuricemia was associated with an increase in inflammatory markers only in patients on diuretic therapy. In a binary logistic regression, hyperuricemia (uric acid >6.0 mg/dL) was independently associated with CKD (eGFR <60 mL/min/1.73 m²) (odds ratio, 2.63; 95% confidence interval, 1.61,4.3; P<.001). In hypertensive women, the presence of hyperuricemia indicated a substantial degree of kidney dysfunction as well as a greater cardiovascular risk profile. [source] Effect of various estimates of renal function on prediction of vancomycin concentration by the population mean and Bayesian methodsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2009Y. Tsuji BSc Summary Objective:, Renal function was estimated in 129 elderly patients with methicillin-resistant Staphylococcus aureus (MRSA) who were treated with vancomycin (VCM). The estimation was performed by substituting serum creatinine (SCR) measured enzymatically and a value converted using the Jaffe method into the Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations. The serum trough level was predicted from three estimates of renal function by the population mean (PM) and Bayesian methods and the predictability was assessed. Methods:, Two-compartment model-based Japanese population parameters for VCM were used, and the mean prediction error (ME) and root mean squared error (RMSE) were calculated as indices of bias and accuracy, respectively, for predictions by the PM and Bayesian methods. Results:, The PM method gave the highest correlation with the measured value using the estimate of renal function obtained by substituting the Jaffe-converted SCR into the Cockcroft-Gault equation. There was no positive or negative bias in the ME and the value was significantly smaller than for other predicted data (P < 0·05). RMSE was also the smallest, indicating that this method increases the predictability of the serum VCM trough level. While, ME showed a negative bias for all values predicted by the Bayesian method, both the ME and RMSE were very small. Conclusion:, In the application of the PM method for VCM treatment of elderly patients with MRSA, substitution of SCR based on the Jaffe method into the Cockcroft-Gault equation increases the predictability of the serum VCM trough level. The Bayesian method predicted the serum VCM trough level with high accuracy using any of the estimates of renal function. [source] Angiokeratoma corporis diffusum (Anderson,Fabry's disease): a case reportJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2 2000Daniela Massi Abstract We report on a 14-year-old boy who presented with a 4-year history of acral pains and febrile episodes. On physical examination, numerous small reddish papules were present on his abdomen, located predominantly on the periumbelical region. Renal function was within normal limits. Ophthalmological examination revealed whorled opacities of the cornea (cornea verticillata) and dilated tortuous conjunctival vessels. Histopathological examination of one of the cutaneous papules showed several dilated blood vessels in the superficial dermis surrounded by collarettes of thickened rete ridges, consistent with a diagnosis of angiokeratoma. The electron-microscopic study of a skin specimen demonstrated the presence of dilated lysosomes with deposition of electron-dense bodies, some of which with laminated structure, in endothelial cells and fibroblasts. These findings were regarded as indicative of Fabry's disease. Subsequent biochemical analysis confirmed the presence of a ,-galactosidase A deficiency in leukocytes. In conclusion, we described the clinical, histopathological and submicroscopic findings of a case of Fabry's disease, in which the combination of electron microscopic and biochemical approaches allowed the correct diagnosis. [source] Renal function and cardiovascular risk profile after conversion from ciclosporin to tacrolimus: prospective study in 80 liver transplant recipientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009S. BECKEBAUM Aliment Pharmacol Ther,30, 834,842 Summary Background, Increased risk of cardiovascular and cerebrovascular disease in liver transplant recipients results in particular from the side effects of calcineurin inhibitor-based immunosuppressive therapy. Several studies have demonstrated a more favourable outcome for patients receiving tacrolimus (TAC) as compared with ciclosporin (CS). Aim, To investigate the effects of conversion from CS to TAC on cardiovascular risk factors and renal function in liver transplant recipients. Methods, In a prospective study, all except two patients had chronic kidney disease stages 2,4 (n = 80), according to estimated glomerular filtration rate using the abbreviated Modification of Diet in Renal Disease equation. Results, Conversion was accompanied with a mean decrease of total cholesterol from 194.6 ± 54.0 mg/dL to 175.8 ± 44.2 mg/dL (P < 0.001), low density lipoprotein cholesterol from 106.7 ± 39.2 mg/dL to 90.9 ± 28.6 mg/dL (P < 0.001) and mean arterial blood pressure values from 102.2 ± 13.2 mm Hg to 95.9 ± 11.7 mm Hg (P < 0.001). Renal function remained stable. No cases of de novo diabetes mellitus were identified. The Framingham risk score was significantly reduced from 5.2 ± 4.4 at baseline to 4.4 ± 5.3 after 12 months (P = 0.006). Conclusions, Conversion from CS to TAC has been shown to improve the cardiovascular risk profile and may retard further decline of renal function after liver transplantation. [source] Effect of tepoxalin on renal function in healthy dogs receiving an angiotensin-converting enzyme inhibitorJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2005M. FUSELLIER The objective of this study was to investigate renal function in clinically normal dogs receiving tepoxalin, a nonsteroidal inflammatory drug, either in association with or without an angiotensin-converting enzyme inhibitor (ACEI). Ten adult female Beagle dogs were used in the three phases of the study. The dogs were administered the drugs once daily for 7 days (experiment 1: placebo/tepoxalin/tepoxalin and benazepril; experiment 2: enalapril/tepoxalin and enalapril) or for 28 days (experiment 3: tepoxalin and benazepril together). Renal function was assessed by measurement of glomerular filtration rate (GFR) by renal scintigraphy [(renal uptake of 99mTc-diethylenetriaminepentacetic acid (DTPA)] and plasma clearance of 99mTc-DTPA. Compared with the placebo group, renal uptake and plasma clearance of 99mTc-DTPA were not significantly modified after a 7-day period of treatment with tepoxalin or enalapril alone, tepoxalin and benazepril or tepoxalin and enalapril together. No significant change was obtained in GFR after a 28-day period of dosing with tepoxalin and benazepril together. Therefore, it was concluded that tepoxalin did not alter renal function in healthy Beagle dogs receiving ACEI. [source] Orthotopic liver transplantation using low-dose tacrolimus and sirolimusLIVER TRANSPLANTATION, Issue 8 2001Vivian C. McAlister MB Although sirolimus (SRL) binds the immunophilin FK506-binding protein-12 (FKBP-12) with greater avidity than tacrolimus (TAC), animal studies have shown that SRL and TAC act synergistically to prevent rejection. Dose-related toxicity is more often the cause of TAC discontinuation than rejection. We hypothesized that SRL would allow for a substantial reduction in the concomitant dose of TAC after liver transplantation to levels less than the threshold for toxicity. A series of 56 liver transplant recipients were administered a combination of SRL and TAC (target trough levels, 7 and 5 ng/mL, respectively). Planned weaning of steroids commenced after 3 months. Pharmacokinetic (PK) studies were undertaken. Patient and graft survival were 52 patients (93%) and 51 grafts (91%), with a follow-up of 23 months (range, 6 to 35 months). One episode (1.8%) of hepatic artery thrombosis was seen. The rate of acute cellular rejection was 14%. No extra treatment was administered in 3 of 8 patients, and the other 5 episodes responded to a single course of steroids. Cytomegalovirus infection occurred in 4 patients (7%). Renal function, glucose control, and lipid metabolism are near normal in 47 patients (84%) without additional medication. Steroid elimination is completed in 51 patients (91%). Bioavailability of SRL and TAC varied between transplant recipients, but trough levels strongly correlated with the area under the curve (r2 = 0.82 and r2 = 0.84, respectively). Simultaneous administration did not affect the PK profile of the drugs at this dose. The ratio of trough level to daily dose correlated between SRL and TAC. The synergistic effect seen in animal models also occurs in clinical liver transplant recipients on SRL-TAC combination immunosuppression. A low-dose combination of SRL and TAC should be compared with conventional immunosuppression in a multicenter, randomized, controlled trial. [source] Change of glomerular filtration rate in healthy adults with agingNEPHROLOGY, Issue 5 2009XUEFENG SUN SUMMARY Aim: In order to determine the relationship between glomerular filtration rate (GFR) and age, the associated factors, and the accurate method of GFR in healthy adults, we conducted a cross-sectional study in community-dwelling adults in Beijing. Methods: Renal function of 201 clinically healthy subjects was determined using technetium-99 m-labelled diethylene triamine pentacetic acid (99mTc-DTPA). Estimated GFR was calculated with the Cockcroft,Gault (CG) equation, abbreviated Modification of Diet in Renal Disease (MDRD) equation, and plasma clearance of creatinine (Ccr). Serum cystatin C, biomarkers of inflammatory and endothelial cells were analyzed as well. Protein intake, carotid artery intima-media thickness and plaque formation were assayed as well. Results: Glomerular filtration rate was negatively associated with age and the correlation coefficient for 99mTc-GFR, CG-GFR, MDRD-GFR, Ccr were ,0.643, ,0.736, ,0.55 and ,0.619, respectively (P < 0.001), while the correlation coefficient between cystatin C and age was 0.681 (P < 0.001). Estimated GFR were associated with measured GFR, and the correlation coefficient for Ccr, CG-GFR and MDRD-GFR were 0.813, 0.582 and 0.418, respectively (P < 0.001). The area under the receiver,operator curve of Ccr was larger, CG was smaller while MDRD was the smallest, and the difference was significant (P < 0.001). So a predicted equation was presented by cystatin C and C-reactive protein for the elderly. Conclusion: In the clinically healthy adults, GFR declined with age. MDRD and CG equation are not suitable to estimate GFR in healthy adults. The predicted equation established by cystatin C and C-reactive protein may be more accurate. [source] Nitric oxide synthesis and nitric oxide synthase expression in the kidney of rats treated by FK506NEPHROLOGY, Issue 1 2002LiMing WANG SUMMARY: FK506-induced nephrotoxicity is characterized by a disturbance in renal haemody-namics that is attributed to an imbalance between the various modulators of renal vascular tone. It has not been well defined whether nitric oxide (NO), as an important vasoactive factor, is involved in FK506-induced nephrotoxicity. This study was designed to evaluate the involvement of nitric oxide in FK506-induced nephrotoxicity by investigating NO synthesis and NO synthase (NOS) expression in the kidney of rats treated with FK506. Male Wistar rats weighing 240,260 g, aged 11 weeks, were administered with FK506 (3.2mg/kg per day i.m.) for 4 weeks. Renal function and urinary NOx was measured using biochemical methods at the end of both 2 and 4 weeks of treatment. Expression of NOS protein and NOS mRNA in the kidney was also investigated using Western blot analysis and reverse transcription/polymerase chain reaction, respectively. FK506 administration induced nephrotoxicity, which was indicated by renal dysfunction (elevated blood urea nitrogen and creatinine, and reduced creatinine clearance, P < 0.05 vs control). FK506-induced nephrotoxicity was accompanied by higher urinary NOx excretion at the end of 2 weeks' treatment. In parallel with an increase in NO synthesis, increased eNOS protein and mRNA expression were also found in the renal medulla and renal cortex at week 2. the expression remained at higher levels in the renal medulla and returned to normal levels in the renal cortex at week 4. FK506 treatment induced nephrotoxicity in rats, which was accompanied by a temporal increase in NO synthesis in the kidney. Increased eNOS protein and mRNA expression were also found in the kidney of treated rats, which may be responsible for the enhanced NO synthesis. [source] Long-term follow-up of renal function after high-dose methotrexate treatment in childrenPEDIATRIC BLOOD & CANCER, Issue 4 2008Marika H. Grönroos MD Abstract Background High-dose methotrexate (HD-MTX) is commonly used in treatment of pediatric leukemias and lymphomas. Transient deterioration in renal function is frequently noted during HD-MTX treatment, but possible long-term changes are less well known. In this study we aimed to study long-term renal prognosis after HD-MTX treatment, and to find possible underlying risk factors for reduced renal function. Procedure Medical records of pediatric cancer patients treated with HD-MTX were reviewed retrospectively after follow-up of 1,10 years. Renal function before and after chemotherapy was investigated in a total of 28 patients. Assessment of glomerular and tubular function was prospectively evaluated in each case. Glomerular function was evaluated by either 51Cr-EDTA or 99mTc-DTPA clearance methods, and by urinary albumin excretion. Tubular function was assessed by measuring blood electrolyte levels and urinary ,1 - or ,2 -microglobulin. Results A decrease in glomerular filtration rate (GFR) was statistically significant as follow-up time increased (P,=,0.02). Age at the time of diagnosis and exposure to potentially nephrotoxic antibiotics during cancer treatment had no influence on GFR. However, albuminuria was observed more often in patients treated with amphotericin B or gentamycin (P,=,0.04). No changes in tubular function were observed. Conclusions Our results show that HD-MTX treatment significantly decreases GFR and may cause albuminuria in pediatric cancer patients several years after treatment. Long-term renal follow-up of these patients is therefore important. Pediatr Blood Cancer 2008;51:535,539. © 2008 Wiley-Liss, Inc. [source] Tacrolimus withdrawal and conversion to sirolimus at three months post-pediatric renal transplantationPEDIATRIC TRANSPLANTATION, Issue 7 2008Leonard C. Hymes Abstract:, Nephrotoxicity caused by CNI may adversely affect long-term graft outcomes. For this reason, we have adopted a protocol for withdrawing TAC and converting to SRL at three months post-renal transplantation. All recipients received basiliximab induction and TAC, MMF, and prednisone. Patients without acute rejection by surveillance biopsy at three months were eligible for SRL conversion. Results: From August 2004 to September 2006, TAC was withdrawn and replaced by SRL in 30 first transplant recipients, who were followed for six to 39 months (mean 18 ± 8). Renal function did not improve significantly after SRL conversion (p = 0.25). Acute rejection occurred in three patients (10%) at five to 12 months after CNI withdrawal. There were no occurrences of wound healing problems, pneumonitis or post-transplant lymphoproliferative disease. Thrombocytopenia and diabetes each occurred in one patient. Four patients received treatment for hypercholesterolemia. CNI withdrawal and replacement with SRL was an effective regimen in children who did not display biopsy evidence of acute rejection at three months post-transplant. While these early results are promising, the ultimate benefit of this protocol to enhance the long-term renal function and graft survival requires ongoing follow-up. [source] Do six-antigen-matched cadaver donor kidneys provide better graft survival to children compared with one-haploidentical living-related donor transplants?PEDIATRIC TRANSPLANTATION, Issue 2 2000A report of the North American Pediatric Renal Transplant Cooperative Study Abstract: Since 1991, more than 50% of pediatric transplant recipients have received a living donor (LD) kidney, and , 85% of these allografts were one-haploidentical parental kidneys. Short-term (1 yr) and long-term (5 yr) graft survival of LD kidneys are 10% and 15% better, respectively, than that of cadaver donor (CD) kidneys. Because of these results, children are frequently not placed on a cadaver waiting list until the possibility of a LD is excluded , a process that may take up to 1 yr. The hypothesis for this study was that the graft outcome of a six-antigen-matched CD kidney is superior to that of a one-haploidentical LD kidney, and that children are at a disadvantage by not being placed on a CD list whilst waiting for a LD. The database of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) for 11 yrs (1987,98), was reviewed to identify children who were recipients of a six-antigen-matched CD kidney (primary and repeat transplants), and those who were recipients of a one-haploidentical LD kidney (primary and repeat transplants). Using standard statistical methods, the morbidity, rejection episodes, post-transplant hospitalizations, renal function, long- and short-term graft survival, and half-life of primary recipients were compared in the two groups. Unlike adult patients, only 2.7% (87/3313) of CD recipients in the pediatric age range received a six-antigen-matched kidney, and the annual accrual rate over 11 yrs was never higher than 4%. Comparison of 57 primary six-antigen-CD kidneys (PCD) with 2472 primary LD (PLD) kidneys revealed that morbidity, rejection rates, and ratios were identical in the two groups. Renal function and subsequent hospitalizations were also identical in the two groups. Five-year graft survival of the PCD group was 90% compared with 80% for the PLD group, and the half-life of the PCD group was 25 ± 12.9 yrs compared with 19.6 ± 1.3 yrs. Our data suggest that the six-antigen-matched CD kidney may have less graft loss as a result of chronic rejection and would therefore confer a better long-term outcome. Based on these findings we recommend that all children, whilst waiting for a LD work-up, be listed with the United Network for Organ Sharing (UNOS) registry for a CD kidney. [source] Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centrePRENATAL DIAGNOSIS, Issue 13 2003Alec Welsh Abstract Objective To audit diagnostic and therapeutic fetal cystoscopy for suspected posterior urethral valves (PUV). Methods In 13 fetuses, (14,28 weeks) the bladder was entered with a 1.3 mm embryo-fetoscope and intravesical findings documented. In 10 fetuses, an attempt was made to treat the obstruction by saline hydro-ablation (n = 4) and/or guide-wire passage (n = 9). Renal function was assessed post-natally at 10 to 34 months. Results The bladder wall was visualised in 12/13 cases and the bladder neck in 11; in 10 cases the upper urethra was entered, and the obstruction visualised in five. PUV were ,seen' in 4/9 confirmed cases, but also in one case of urethral atresia, while in two others the degree of resistance to guide-wire passage suggested atresia or prune belly. Therapeutic attempts were technically successful, at least initially, in 6/10 cases. Of the five cases with confirmed PUV and normal fetal urinary electrolytes, two have acceptable renal function at follow-up. Hydro-ablation in one case resulted in resolution of sonographic signs of obstruction, and ablated valves were confirmed post-natally. Conclusions Semi-rigid fetal cystoscopy allows entry into the upper urethra in most obstructive uropathies, although bladder neck angulation precludes visualisation of the site of obstruction in the majority. Guide-wire passage or hydro-ablation may allow relatively atraumatic ablation of PUV in utero without the chronic bladder decompression associated with vesico-amniotic shunting. However, current technical limitations need to be overcome, possibly by the use of flexible or angled fetoscopes, before the role of cystoscopic treatment can be formally evaluated. Copyright © 2003 John Wiley & Sons, Ltd. [source] Renal Failure Five Years After Lung Transplantation Due to Polyomavirus BK-Associated NephropathyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010A. Egli Polyomavirus-associated nephropathy (PyVAN) is rare in nonrenal solid organ transplantation and only limited information is available from single cases. We describe a 67-year-old female presenting with hypertension and progressive kidney failure due to PyVAN 60 months after lung transplantation. Plasma BK virus (BKV) loads were 4.85 log10 copies/mL at diagnosis and cleared slowly over 14 months after switching from tacrolimus, mycophenolate and prednisone to low-dose tacrolimus, sirolimus and leflunomide, the latter being discontinued for anemia and diarrhea. BKV- and JC virus-specific immunoglobulins were detectable prior to transplantation. Only BKV-specific IgG and IgM increased during follow-up. BKV-specific T cells were detectable in blood following in vitro expansion, but cleared with reincreased sirolimus, yet BKV viremia remained undetectable. We identified eight other cases of PyVAN in nonrenal solid organ transplantation including lung (n = 1), heart (n = 6) and pancreas (n = 1). Overall, diagnosis was later than commonly seen in kidney transplants (median 18 months, interquartile range 10,29). Seven patients were male, five received triple immunosuppression consisting of tacrolimus, mycophenolate, prednisone. Immunosuppression was reduced in four cases and cidofovir and/or leflunomide administered in five and two cases, respectively. Renal function deteriorated in five requiring hemodialysis in four. We discuss mTOR inhibitors versus cidofovir and leflunomide as potential PyVAN rescue therapy. [source] Cold Machine Perfusion Versus Static Cold Storage of Kidneys Donated After Cardiac Death: A UK Multicenter Randomized Controlled TrialAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010C. J. E. Watson One third of deceased donor kidneys for transplantation in the UK are donated following cardiac death (DCD). Such kidneys have a high rate of delayed graft function (DGF) following transplantation. We conducted a multicenter, randomized controlled trial to determine whether kidney preservation using cold, pulsatile machine perfusion (MP) was superior to simple cold storage (CS) for DCD kidneys. One kidney from each DCD donor was randomly allocated to CS, the other to MP. A sequential trial design was used with the primary endpoint being DGF, defined as the necessity for dialysis within the first 7 days following transplant. The trial was stopped when data were available for 45 pairs of kidneys. There was no difference in the incidence of DGF between kidneys assigned to MP or CS (58% vs. 56%, respectively), in the context of an asystolic period of 15 min and median cold ischemic times of 13.9 h for MP and 14.3 h for CS kidneys. Renal function at 3 and 12 months was similar between groups, as was graft and patient survival. For kidneys from controlled DCD donors (with mean cold ischemic times around 14 h), MP offers no advantage over CS, which is cheaper and more straightforward. [source] Biopsy-Diagnosed Renal Disease in Patients After Transplantation of Other Organs and TissuesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010A. Schwarz Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolytic-uremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI. [source] | |||||||||||||||||||||||||||||||||||||||||||