RESUMEN
BACKGROUND: Glomerular filtration rate (GFR) estimation in older adults using a creatinine clearance/24-hour (CrCl) or an equation based on serum creatinine, are often considered equivalent by clinicians. AIM: To compare GFR estimated (eGFR) with the available equations and measured CrCl in patients ≥ 70 years. A secondary aim was to know the differences in chronic kidney disease (CKD) classification, when using the different eGFR formulas. PATIENTS AND METHODS: In 144 patients aged 77 ± 5 years (58% men), CrCl was measured and GFR was estimated using MDRD, CKD-EPI, BIS-1 and FAS formulas. The eGFR and the stage of CKD were compared according to the different equations used. RESULTS: GFR estimated by MDRD and CKD-EPI equations was 7.8 and 8.4 mL/min/1.73 m2 lower than 24-hour ClCr, respectively. This difference was even greater using the BIS-1 and FAS equations. Twenty-four-hour CrCl classified 47.2% of the patients in a category of renal function > 60 mL/min/1.73 m2, while MDRD and CKD-EPI equations classified just over a third, and BIS-1 and FAS formulas around 20% of the patients. CONCLUSIONS: The practice of considering equivalent the GFR estimation using the creatinine-based equations with measured creatinine clearance in older adults should be reconsidered, because their results differ markedly.
Asunto(s)
Insuficiencia Renal Crónica , Anciano , Creatinina , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Insuficiencia Renal Crónica/diagnósticoRESUMEN
Background: Glomerular filtration rate (GFR) estimation in older adults using a creatinine clearance/24-hour (CrCl) or an equation based on serum creatinine, are often considered equivalent by clinicians. Aim: To compare GFR estimated (eGFR) with the available equations and measured CrCl in patients ≥ 70 years. A secondary aim was to know the differences in chronic kidney disease (CKD) classification, when using the different eGFR formulas. Patients and Methods: In 144 patients aged 77 ± 5 years (58% men), CrCl was measured and GFR was estimated using MDRD, CKD-EPI, BIS-1 and FAS formulas. The eGFR and the stage of CKD were compared according to the different equations used. Results: GFR estimated by MDRD and CKD-EPI equations was 7.8 and 8.4 mL/min/1.73 m2 lower than 24-hour ClCr, respectively. This difference was even greater using the BIS-1 and FAS equations. Twenty-four-hour CrCl classified 47.2% of the patients in a category of renal function > 60 mL/min/1.73 m2, while MDRD and CKD-EPI equations classified just over a third, and BIS-1 and FAS formulas around 20% of the patients. Conclusions: The practice of considering equivalent the GFR estimation using the creatinine-based equations with measured creatinine clearance in older adults should be reconsidered, because their results differ markedly.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Insuficiencia Renal Crónica/diagnóstico , Creatinina , Tasa de Filtración GlomerularRESUMEN
Background: Evaluation of 24-hour collection accuracy is based on urinary creatinine excretion (UCr), usually using wide ranges indexed by weight. Equations that predict the expected UCr are also available. Aim: To generate an equation for estimating UCr in Chilean population and evaluate its performance in comparison to existing formulas. Material and Methods: A total of 464 24-hour urine collections from outpatients aged between 15 and 88 years old were used. Ninety percent of collections (n = 418) were randomly extracted to assess the association between absolute UCr values with sex, age, height and weight of participants. A formula was created to estimate the 24-hour UCr using a multiple linear regression model. In the remaining 10% of urine collections (n = 46), the performance of this formula and others reported in the literature were tested. Results: Age, sex and weight were significantly associated with 24-hour UCr values. The new equation was able to predict UCr values with a similar accuracy than CKD-EPI and Walser equations and outperformed other equations. Conclusions: Our equation developed with Chilean values predicts 24-hour UCr values accurately.
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Creatinina/orina , Peso Corporal , Modelos Lineales , Chile , Tasa de Filtración GlomerularRESUMEN
Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels < 3 µg/mL, acetaminophen levels < 1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.
Asunto(s)
Humanos , Femenino , Adulto , Atrofia Muscular Espinal/complicaciones , Cetosis/etiología , Estrés Fisiológico , Bicarbonatos , GlucosaRESUMEN
BACKGROUND: Evaluation of 24-hour collection accuracy is based on urinary creatinine excretion (UCr), usually using wide ranges indexed by weight. Equations that predict the expected UCr are also available. AIM: To generate an equation for estimating UCr in Chilean population and evaluate its performance in comparison to existing formulas. MATERIAL AND METHODS: A total of 464 24-hour urine collections from outpatients aged between 15 and 88 years old were used. Ninety percent of collections (n = 418) were randomly extracted to assess the association between absolute UCr values with sex, age, height and weight of participants. A formula was created to estimate the 24-hour UCr using a multiple linear regression model. In the remaining 10% of urine collections (n = 46), the performance of this formula and others reported in the literature were tested. RESULTS: Age, sex and weight were significantly associated with 24-hour UCr values. The new equation was able to predict UCr values with a similar accuracy than CKD-EPI and Walser equations and outperformed other equations. CONCLUSIONS: Our equation developed with Chilean values predicts 24-hour UCr values accurately.
Asunto(s)
Creatinina/orina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Peso Corporal , Chile , Tasa de Filtración Glomerular , Humanos , Modelos Lineales , Persona de Mediana Edad , Adulto JovenRESUMEN
Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels < 3 µg/mL, acetaminophen levels < 1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.