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Rationale and Objective: The NKF-ASN Task Force recommends accurate kidney function estimation avoiding biases through racial adjustments. We explored the use of multiple kidney function biomarkers and hence estimated glomerular filtration rate (eGFR) equations to improve kidney function calculations in an ethnically diverse patient population. Study design: Prospective community cohort study. Setting and Participants: rural New Mexico clinic with patients > 18 yo. Methods: Markers of kidney function, IDMS-Creatinine (SCr), chemiluminescence Beta-2 Microglobulin (B2M), Nephelometry-calibrated ELISA Cystatin C (CysC), inflammation, glucose tolerance, demographics, BUN/UACR from the baseline visit of the COMPASS cohort, were analyzed by Kernel-based Virtual Machine learning methods. Results: Among 205 participants, the mean age was 50.1, 62% were female, 54.1% Hispanic American and 30.2% Native American. Average kidney function biomarkers were: SCr 0.9 mg/dl, B2M 1.8 mg/L, and CysC 0.7 mg/dl. The highest agreement was observed between SCr and B2M-based eGFR equations [mean difference in eGFRs: (4.48 ml/min/1.73m2], and the lowest agreement between B2M and CysC-based eGFR equations (-24.75 ml/min/1.73m2). There was no pattern of association between the differences in eGFR measures and gender. In the continuous analyses, the absolute eGFR value (p<2 x 10-16) and serum albumin (p =6.4 x 10-5) predicted the difference between B2M- and SCr-based e-GFR. The absolute eGFR value (p<2 x 10-16) and age (p =7.6 x 10-5) predicted the difference between CysC- and SCr-based e-GFR. Limitations: Relatively small sample size, elevated inflammatory state in majority of study participants and no inulin excretion rate measurements. Conclusion: B2M should be strongly considered as a kidney function biomarker fulfilling the criteria for the NKF-ASN. B2M's eGFR equation does not need adjustment for gender or race and showed the highest agreement with SCr-based eGFR equations.
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ABSTRACT Patients with inflammatory bowel disease (IBD) are prone to develop kidney injury. Renal involvement in IBD patients is usually diagnosed by the measurement of serum creatinine and the estimation of the glomerular filtration rate. We describe a patient with IBD who presented with large fluctuations in his serum creatinine level (~3.0-fold) without significant histologic abnormalities and with a normal cystatin C level. This appears to be related to a high-protein diet and intermittent fasting. Even though the impact of a high-protein diet on mild elevations of the serum creatinine level has been described, large fluctuations in serum creatinine from diet alone, as seen in this case, have never been reported, raising the question about the potential contribution of inflamed bowel on gut absorption or metabolism of creatinine. This case highlights the importance of a detailed history, including the dietary habits, when encountering a patient with increased serum creatinine level, and careful interpretation of serum creatinine in a patient with a creatinine high-protein diet or underlying IBD.
RESUMO Pacientes com doença inflamatória intestinal (DII) são propensos a desenvolver lesão renal. O envolvimento renal em pacientes com DII é geralmente diagnosticado pela medição da creatinina sérica e pela estimativa da taxa de filtração glomerular. Descrevemos um paciente com DII que apresentou grandes flutuações em seu nível de creatinina sérica (~3,0 vezes) sem anormalidades histológicas significativas e com nível normal de cistatina C. Isso parece estar relacionado a uma dieta rica em proteínas e jejum intermitente. Ainda que o impacto de uma dieta rica em proteínas em elevações leves do nível de creatinina sérica tenha sido descrito, nunca foram relatadas grandes flutuações na creatinina sérica apenas devido à dieta, como observado neste caso, o que levanta a questão sobre a possível contribuição do intestino inflamado na absorção intestinal ou no metabolismo da creatinina. Esse caso destaca a importância de um histórico detalhado, incluindo os hábitos alimentares, ao se deparar com um paciente com nível de creatinina sérica aumentado, e a interpretação cuidadosa da creatinina sérica em um paciente com dieta rica em proteínas ou DII subjacente.
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Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.
Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.
Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.
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BACKGROUND: Long-term kidney outcomes of non-dialyzed children with Shiga-toxin Escherichia Coli hemolytic uremic syndrome (STEC-HUS) have been scantily studied. Therefore, we aimed to evaluate kidney outcomes and prognostic markers in these patients. METHODS: Non-dialyzed STEC-HUS patients followed for at least 5 years were included. They were grouped and compared according to kidney status at last visit: complete recovery (CR) or chronic kidney disease (CKD). Predictors of CKD evaluated at diagnosis were sex, age, leukocytes, hematocrit, hemoglobin (Hb), and serum creatinine (sCr). Peak sCr and time of follow-up were also analyzed. RESULTS: A total of 122 patients (62 female, median age at diagnosis 1.6 years) with a median follow-up of 11.3 years were included. At last visit, 82 (67%) had CR, 36 (30%) had CKD stage 1, and 4 (3%) had stage 2. No patient developed CKD stage 3-5. Median time to CKD was 5 years (IQR 3.1-8.76 years). Of the 122 patients, 18% evolved to CKD in the first 5 years, increasing to 28% at 10 and 33% at 20 years of follow-up. Serum Cr at diagnosis and peak sCr were significantly higher in patients with CKD than in those with CR. CONCLUSIONS: One third of non-dialyzed STEC-HUS patients evolved to CKD after a median time of 5 years. However, CKD may appear even after 15 years of CR. Serum Cr was significantly higher among patients who evolved to CKD. These data reinforce that all non-dialyzed patients should be followed until adulthood. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Infecciones por Escherichia coli , Síndrome Hemolítico-Urémico , Insuficiencia Renal Crónica , Escherichia coli Shiga-Toxigénica , Niño , Humanos , Femenino , Adulto , Lactante , Toxina Shiga , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Riñón , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/terapia , Síndrome Hemolítico-Urémico/diagnóstico , Insuficiencia Renal Crónica/complicacionesRESUMEN
The present experimental work was conducted to elucidate the toxicity of nimesulide at three different doses in black kites (Milvus migrans). M. migrans is one of the most common raptors near human habitations. The goal of the current investigation was to determine whether nimesulide is similarly hazardous to raptors as was diclofenac sodium and to investigate the acute oral toxicity of nimesulide in these birds. For this study, eight adult male black kites (M. migrans) were randomly divided into four groups. M. migrans in the control group (n = 02) were not treated with nimesulide. The other three groups were given nimesulide doses. The birds in the first (n = 02) were declared the control group. The second (n = 02), third (n = 02), and fourth groups were administered nimesulide at a low, medium, and high dose of 2, 4, and 6 mg/kg live body weight of bird/day, respectively, for 10 days. Nimesulide-addled birds became listless and despondent, then anorexic. The birds were standing there with their eyes closed and showing no signs of life. There was an increase in saliva production, a slowing of breathing, and dilated pupils. No clinical signs were observed in the control group. No mortality was seen in the control or treated groups. The control group did not show lesions of gout, but black kites intoxicated with nimesulide at 2, 4, and 6 mg/kg live body weight of bird/day showed inflammation, apoptosis, hemorrhage, necrosis, and leukocytic infiltration tissues of the liver, kidney, and heart of black kites (M. migrans) treated with different concentrations of nimesulide. The treated groups also showed apoptosis of myofibrils and hyperplasia. The hypertrophy, atrophy, fibrosis, necrosis of skeletal muscles and hemorrhage were prominent in the muscles of black kites (M. migrans) intoxicated with nimesulide. All observed histological alterations got worse in a dose-related way. There was no significant difference in AST, ALT, ALP, serum uric acid, but a significant difference was observed in the values of serum urea (p = 0.001) and serum creatinine (p = 0.019).
O presente trabalho experimental foi conduzido para elucidar a toxicidade da Nimesulida em três doses diferentes em milhafres (Milvus migrans). M. migrans é uma das aves de rapina mais comuns perto de habitações humanas. O objetivo da presente investigação foi determinar se a Nimesulida é igualmente perigosa para as aves de rapina como foi o diclofenaco sódico e investigar a toxicidade oral aguda do fármaco nessas aves. Para este estudo, 8 milhafres machos adultos (M. migrans) foram aleatoriamente divididos em 4 grupos. M. migrans no grupo controle (n = 2) não foram tratados com Nimesulida. Os outros 3 grupos receberam doses do fármaco. As aves do primeiro grupo (n = 2) foram declaradas o grupo controle. O segundo (n = 2), terceiro (n = 2) e quarto grupos receberam Nimesulida nas doses baixa, média e alta de 2, 4 e 6 mg/kg de peso corporal vivo da ave/dia, respectivamente, por 10 dias. Aves confusas com Nimesulida tornaram-se apáticas e desanimadas, depois anoréxicas. Os pássaros estavam parados com os olhos fechados e sem sinais de vida. Houve um aumento na produção de saliva, lentidão na respiração e pupilas dilatadas. Nenhum sinal clínico foi observado no grupo controle. Nenhuma mortalidade foi observada nos grupos de controle ou tratados. O grupo controle não apresentou lesões de gota, mas os milhafres intoxicados com Nimesulida nas doses de 2, 4 e 6 mg/kg peso vivo da ave/dia apresentaram inflamação, apoptose, hemorragia, necrose e infiltração leucocitária nos tecidos do fígado, rim e coração de milhafre-preto tratados com diferentes concentrações de Nimesulida. Os grupos tratados também apresentaram apoptose de miofibrilas e hiperplasia. A hipertrofia, atrofia, fibrose, necrose da musculatura esquelética e hemorragia foram proeminentes nos músculos de milhafres negros intoxicados com o fármaco. Todas as alterações histológicas observadas pioraram de forma dose-dependente. Não houve diferença significativa em AST, ALT, ALP, ácido úrico sérico, no entanto, foi observada diferença significativa nos valores de ureia sérica (p = 0,001) e creatinina sérica (p = 0,019).
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Animales , Aves , Quimioterapia , Antiinflamatorios/toxicidadRESUMEN
Objectives: The study objectives were to describe the incidence, risk factors, and outcomes of acute kidney injury after cardiopulmonary bypass in Jamaica. Method: We performed a review of the medical records of adult patients (aged ≥ 18 years) with no prior dialysis requirement undergoing cardiopulmonary bypass at the University Hospital of the West Indies, Mona, between January 1, 2016, and June 30, 2019. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes criteria. The primary outcomes were acute kidney injury incidence and all-cause 30-day mortality. Multivariable logistic regression and Cox proportional analyses were used to examine the association between the acute kidney injury risk factors and the primary outcome. Results: Data for 210 patients (58% men, mean age 58.1 ± 12.9 years) were analyzed. Acute kidney injury occurred in 80 patients (38.1%), 44% with Kidney Disease Improving Global Outcomes I, 33% with Kidney Disease Improving Global Outcomes II, and 24% with Kidney Disease Improving Global Outcomes III. From multivariable logistic regression models, European System for Cardiac Operative Risk Evaluation II (odds ratio, 1.19; 95% confidence interval, 1.01-1.39 per unit), bypass time (odds ratio, 1.94; 95% confidence interval, 1.40-2.67 per hour), perioperative red cell transfusion (odds ratio, 3.03; 95% confidence interval, 1.36-6.76), and postoperative neutrophil lymphocyte ratio (odds ratio, 1.65; 95% confidence interval, 1.01-2.68 per 10-unit difference) were positively associated with acute kidney injury. Acute kidney injury resulted in greater median hospital stay (18 vs 11 days, P < .001) and intensive care unit stay (5 vs 3 days, P < .001), and an 8-fold increase in 30-day mortality (hazard ratio, 8.15; 95% confidence interval, 2.76-24.06, P < .001). Conclusions: Acute kidney injury after cardiopulmonary bypass surgery occurs frequently in Jamaica and results in poor short-term outcomes. Further studies coupled with quality interventions to reduce the mortality of those with acute kidney injury are needed in the Caribbean.
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BACKGROUND AND OBJECTIVES: Data on urine output have not been routinely presented to define cardiac surgery-related acute kidney injury (AKI). We evaluated the incidence of AKI after cardiac surgery based on the AKIN and KDIGO criteria (considering serum creatinine concentration and urine output in the first 72 hours postoperatively) and compared the performance of the 2 criteria for AKI staging. METHODS: This was a prospective cohort study of adult patients undergoing coronary artery bypass grafting (CABG), valve replacement, or CABG + valve replacement between October 2017 and April 2018 at a single institution. Patients were excluded if baseline creatinine concentration (measured within 7 days before surgery) was ≥ 2.5 mg.dL-1. Patients were evaluated for the development of AKI based on changes in urine output and serum creatinine concentration, measured daily from postoperative day 1 to 7, according to the AKIN and KDIGO criteria, which were then compared. RESULTS: A total of 198 patients were included. AKI occurred in 83.8% by AKIN and in 82.8% by KDIGO, when using both urine output and serum creatinine concentration as defining criteria. Using serum creatinine concentration alone, the incidence of AKI fell to 27.3% by AKIN and to 24.7% by KDIGO. A kappa coefficient of 0.98 was obtained between the AKIN and KDIGO criteria. CONCLUSIONS: Almost perfect agreement was found between AKIN and KDIGO. AKI may be underdiagnosed after cardiac surgery if serum creatinine concentration is used as the only defining criterion. Our findings underscore the fundamental importance of using the urine output criterion in the assessment of patients at risk for AKI.
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Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Creatinina , Humanos , Incidencia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: We established the prevalence and predictors of persisting hypertension in women with preeclampsia admitted at the Carlos Manuel de Cèspedes Teaching Hospital in Cuba so as to guide the health-care providers in early identification of the patients at risk for timely intervention. PATIENTS AND METHODS: A three-year prospective cohort study was conducted between March 2017 and March 2020. A cohort of 178 women diagnosed with preeclampsia at the hypertension unit of Carlos Manuel de Cèspedes Teaching Hospital were recruited. Interviewer administered questionnaires and laboratory and ultrasound scan result forms were used to collect the data. Binary logistic regression was conducted to determine the predictors. All data analyses were conducted using STATA version 14.2. RESULTS: Forty-five (27.8%) of the studied 162 patients were still hypertensive at 12 weeks postpartum. Maternal age of 35 years or more (aRR=1.14,95% CI:1.131-4.847, p=0.022), early onset preeclampsia (before 34 weeks of gestation) (aRR=7.93, 95% CI:1.812-34.684, p=0.006), and elevated serum creatinine levels of more than 0.8mg/dl (aRR=1.35, 95% CI:1.241-3.606, p=0.032) were the independent predictors of persisting hypertension at 12 weeks postpartum. CONCLUSION: Recognition of these predictors and close follow-up of patients with preeclampsia will improve the ability to diagnose and monitor women likely to develop persisting hypertension before its onset for timely interventions.
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Resumen OBJETIVO: Cuantificar la hemorragia intraparto y la concentración sérica posparto de creatinina para calcular su correlación y determinar la frecuencia de lesión renal aguda en mujeres que terminaron el embarazo mediante cesárea. MATERIALES Y MÉTODOS: Estudio transversal y retrospectivo efectuado en mujeres que terminaron el embarazo mediante cesárea entre el 1 de enero y el 31 de diciembre de 2019 en el Hospital de Ginecología y Obstetricia 3 del IMSS. De los expedientes clínicos se obtuvieron la cantidad de hemorragia intraparto y el valor de creatinina para calcular su correlación y la frecuencia de lesión renal aguda (creatinina posparto mayor de 1 mg/dL). Se aplicaron: estadística descriptiva, t de Student y coeficiente de correlación de Pearson (r). RESULTADOS: Se registraron 114 pacientes con 32.44 ± 7.11 años de media de edad y 32.55 ± 4.18 semanas de embarazo, 558.11 ± 570.62 mL de hemorragia posparto y 0.77 ± 0.21 mg/dL de creatinina posparto. La correlación de la hemorragia intraparto vs creatinina posparto fue r = 0.158 y de hemorragia obstétrica (más de 1000 mL) vs creatinina posparto r = 0.390. La frecuencia de lesión renal aguda fue 14.03% (n = 16) y de requerimiento de diálisis 2.42% (n = 3). CONCLUSIONES: La cantidad de la hemorragia intraparto fue aceptable, con baja frecuencia de hemorragia obstétrica. La creatinina posparto se incrementó significativamente. La correlación hemorragia intraparto vs creatinina posparto resultó positiva e incrementó su significación conforme fue mayor la cantidad de sangrado. Se encontró bajo porcentaje de lesión renal aguda y de requerimientos de diálisis.
Abstract OBJECTIVE: To quantify intrapartum hemorrhage and serum creatinine (Cr) postpartum concentration to calculate its correlation and determine the frequency of acute kidney injury in patients undergoing caesarean section. MATERIALS AND METHODS: Cross-sectional and retrospective study carried out in women who ended their pregnancy by caesarean section between January 1 and December 31, 2019 at the Hospital for Gynecology and Obstetrics 3 of the IMSS. The clinical records were consulted to calculate the amount of intrapartum hemorrhage and the value of Cr to determine its correlation and the frequency of acute kidney injury (postpartum Cr >1 mg/dL). Statistical analysis: descriptive statistics, Student's T test and Pearson's correlation coefficient (r). RESULTS: The mean age was 32.44 ± 7.11 years with gestational age 32.55 ± 4.18 weeks, intrapartum hemorrhage 558.11 ± 570.62 mL and postpartum Cr 0.77 ± 0.21 mg/dL. The correlation of intrapartum hemorrhage vs postpartum Cr was r = 0.158 and obstetric hemorrhage (> 1,000 mL) vs postpartum Cr r = 0.390. The frequency of AKI was 14.03% (16 cases) and dialysis requirements 2.42% (3 cases). CONCLUSIONS: The amount of intrapartum hemorrhage was acceptable with low frequency of obstetric hemorrhage. Postpartum Cr increased significantly. The intrapartum hemorrhage vs postpartum Cr correlation was positive which increased its significance as the amount of bleeding increased. Low percentage of acute kidney injury and dialysis requirements was found.
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Se llevó a cabo un estudio observacional, descriptivo, de serie de casos, en 144 pacientes con diabetes mellitus de tipo 2, atendidos en el Laboratorio Clínico del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba, de mayo de 2017 a igual de 2018, procedentes de la consulta de Endocrinología del propio hospital, con vistas a evaluar la utilidad de la cistatina C como biomarcador precoz de daño renal. En la investigación predominaron los pacientes de más de 50 años de edad y del sexo femenino, además de la hipertensión arterial como enfermedad asociada y la neuropatía periférica como complicación. Se concluyó que la cistatina C es útil como biomarcador precoz de daño renal en pacientes con diabetes mellitus de tipo 2, fundamentalmente si existen comorbilidades y complicaciones que pudieran conducir a la enfermedad renal crónica, lo que puede prevenirse.
An observational, descriptive series of cases study, was carried out in 144 patients with diabetes mellitus type 2, assisted in the Clinical Laboratory of Saturnino Lora Torres Teaching Provincial Hospital in Santiago de Cuba from May, 2017 to the same month of 2018, who were from the Endocrinology Service of the same hospital, with the aim of evaluating the utility of the Cystatin C as early biomarker of renal damage. Patients older than 50 years of age and female sex, besides hypertension as associated disease and the outlying neuropathy as complication prevailed in the investigation. It was concluded that Cystatin C is useful as early biomarker of renal damage in patients with diabetes mellitus type 2, fundamentally if there are comorbidities and complications that could cause chronic renal failure, which can be prevented.
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Diabetes Mellitus Tipo 2 , Insuficiencia Renal Crónica , Cistatina CRESUMEN
BACKGROUND: After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups. METHODS: Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC = 0.98, 95% confidence interval (CI), 0.91-1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC = 0.88; 95% CI 0.80-0.99). CONCLUSIONS: Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.
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Pruebas de Función Renal , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Adolescente , Adulto , Albuminuria/etiología , Albuminuria/orina , Área Bajo la Curva , Creatinina/sangre , Creatinina/orina , Cistatina C/sangre , Progresión de la Enfermedad , Enfermedades Endémicas , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Lipocalina 2/sangre , Masculino , Nicaragua/epidemiología , Curva ROC , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/orina , Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
RATIONALE & OBJECTIVE: Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN. STUDY DESIGN: Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI. SETTING & PARTICIPANTS: 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI. PREDICTOR: AKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL. OUTCOMES: Kidney function trajectory and development of CKD over 12 months. ANALYTICAL APPROACH: Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects. RESULTS: 34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate. LIMITATIONS: Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury. CONCLUSIONS: In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.
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Lesión Renal Aguda/inducido químicamente , Enfermedades Profesionales/etiología , Insuficiencia Renal Crónica/inducido químicamente , Insuficiencia Renal Crónica/epidemiología , Saccharum/efectos adversos , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/fisiopatología , Adulto , América Central/epidemiología , Creatinina/sangre , Estudios Transversales , Bases de Datos Factuales , Progresión de la Enfermedad , Agricultores/estadística & datos numéricos , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/fisiopatología , Salud Laboral , Prevalencia , Insuficiencia Renal Crónica/fisiopatología , Estudios Retrospectivos , Medición de RiesgoRESUMEN
Identifying those children with complicated forms of diarrhea-associated hemolytic uremic syndrome (D+HUS) on admission can optimize their management. Recently, the blood urea nitrogen to serum creatinine ratio (BCR) at admission has been proposed as a novel and accurate predictor of complicated clinical outcome in D+HUS; therefore, we performed this retrospective study aimed to validate such observation in a larger series of patients. A complicated course was defined as developing one or more of the following: severe neurological or bowel injury, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, hemorrhage, and death. Data from 161 children were reviewed, 50 of them with a complicated disease including five deaths. Those with worse evolution presented a lower admission BCR than those with good outcome (22.5 vs. 30.8; p = 0.005). BCR at admission showed a limited ability to identify children at risk of a complicated course, with an AUC of 0.63 (95% CI 0.58-0.71) and an optimal cutoff point of ≤ 26.7, which achieves a sensitivity of 70% (95% CI 55.2-81.7) and a specificity of 56.7% (95% CI 47-66). CONCLUSION: In this validation study, the BCR at admission provided a limited value to predict severe forms of D+HUS. What is Known: ⢠BCR at admission has been proposed as an accurate predictor of complicated clinical course in children with D+HUS. What is New: ⢠In a larger series of children with D+HUS, we were unable to confirm the usefulness of the admission BCR to early identify those at risk of complicated forms of the disease. ⢠Further research is warranted to improve the optimal detection of these high-risk patients.
Asunto(s)
Nitrógeno de la Urea Sanguínea , Creatinina/sangre , Diarrea/complicaciones , Síndrome Hemolítico-Urémico/diagnóstico , Biomarcadores/sangre , Niño , Preescolar , Femenino , Síndrome Hemolítico-Urémico/sangre , Síndrome Hemolítico-Urémico/etiología , Humanos , Lactante , Masculino , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Resumen OBJETIVO: Determinar la correlación entre las concentraciones de ácido úrico y creatinina en pacientes con preeclampsia severa para conocer su utilidad clínica. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y analítico al que se incluyeron pacientes con preeclampsia severa. A la admisión al estudio se registraron las concentraciones sanguíneas de ácido úrico y creatinina para calcular la correlación de las medias generales y por categorías. Se utilizó estadística descriptiva, prueba t de Student, IC95% y coeficiente de correlación de Pearson con el programa estadístico SPSS versión 20. RESULTADOS: Se estudiaron 100 pacientes con preeclampsia severa. La media ge-neral de ácido úrico fue de 5.52 ± 1.43 mg/dL; 85% tuvieron hiperuricemia y 17% hiperuricemia extrema. La media general de creatinina fue de 0.77 ± 0.25 mg/dL; 18% resultaron con hiperazoemia y 14% con hiperazoemia extrema. CONCLUSIONES: El ácido úrico y la creatinina tuvieron correlaciones positivas: a mayor hiperuricemia mayor deterioro de la función renal. Ambos pueden ser marcadores complementarios útiles para identificar la lesión renal aguda en la preeclampsia severa.
Abstract OBJECTIVE: To determine the correlation of uric acid and creatinine in pregnant patients with severe preeclampsia to identify its clinical utility. MATERIAL AND METHOD: cross- sectional study that included 100 pregnant patients with severe preeclampsia. Blood levels of uric acid and creatinine were recorded upon admission to calculate the correlation of the general means and by categories. (Normal uric acid ≤ 4 mg/dL, hyperuricemia > 4 mg/dL and extreme hyperuricemia ≥7 mg/dL vs normal creatinine ≤ 0.9 mg/dL, hyperazotemia > 0.9 mg/dL and extreme hiperazoemia ≥ 1.1 mg/dL). Descriptive statistics, Student's T- test, Confidence inter-vals (CI) and Pearson's correlation coefficient were used with the statistical program SPSS version 20. RESULTS: 100 patients with severe preeclampsia were studied. The general average of uric acid was 5.52 ± 1.43 mg / dL; 85% had hyperuricemia and 17% extreme hy-peruricemia. The general average of creatinine was 0.77 ± 0.25 mg / dL; 18% resulted with hyperazotemia and 14% with extreme azotemia. CONCLUSIONS: Uric acid and creatinine showed positive correlations. It was found that the greater the degree of hyperuricemia, the greater the deterioration of renal function. Both markers can be complemented to identify acute kidney injury in severe preeclampsia.
RESUMEN
BACKGROUND: Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI. METHODS: This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008. Intensive UO monitoring was defined as hourly recordings and no gaps > 3 hours for the first 48 hours after ICU admission. RESULTS: Intensive monitoring for UO was conducted in 4,049 patients (26%), and we found significantly higher rates of AKI (OR, 1.22; P < .001) in these patients. After adjustment for age and severity of illness, intensive UO monitoring was associated with improved survival but only among patients experiencing AKI. With or without AKI, patients with intensive monitoring also had less cumulative fluid volume (2.98 L vs 3.78 L; P < .001) and less fluid overload (2.49% vs 5.68%; P < .001) over the first 72 hours of ICU stay. CONCLUSIONS: In this large ICU population, intensive monitoring of UO was associated with improved detection of AKI and reduced 30-day mortality in patients experiencing AKI, as well as less fluid overload for all patients. Our results should help inform clinical decisions and ICU policy about frequency of monitoring of UO, especially for patients at high risk of AKI or fluid overload, or both.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Unidades de Cuidados Intensivos , Monitoreo Fisiológico/métodos , Micción/fisiología , Lesión Renal Aguda/fisiopatología , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de TiempoRESUMEN
El presente artículo intentará demostrar por qué es necesario mejorar el control de calidad de los laboratorios clínicos y avanzar hacia la estandarización de la creatininemia para contribuir a mejorar el diagnóstico clínico y epidemiológico de la Enfermedad Renal Crónica especialmente en América Latina. El rol del laboratorio de análisis clínico es brindar información útil, confiable y reproducible para la práctica clínica de la medicina, cualquiera sea la metodología empleada y el laboratorio interviniente. Para ello se implementó calidad para mejorar los errores sistemático y aleatorio en las determinaciones de los laboratorios clínicos. Los programas de estandarización se ponen en marcha en el año 2006. Por otra parte se fue incorporando la creatinina sérica y el clearance de creatinina a la clínica, hasta arribarse a un hito histórico que fue la determinación de la Tasa Filtrado Glomerular estimada (TFGe) a partir de fórmulas (MDRD y CKD-EPI). La necesidad de la estandarización de la determinación de la creatinina fue establecida en la Guía 4, KDOQUI en el año 2002. Respecto a la determinación de la creatinina sérica para la estimación del TFGe, un largo camino se ha recorrido desde la identificación del concepto de clearance, su aplicación a la determinación de la función renal, su utilización en la clínica para el diagnóstico, la progresión y el pronóstico, la identificación de la misma como un indicador epidemiológico a la hora de establecer riesgo poblacional. En ese marco, se manifiesta la necesidad de promover su estandarización
This article attempts to show why it is necessary to improve quality control of clinical laboratories and move toward standardization of serum creatinine to help improve clinical and epidemiological diagnosis of chronic kidney disease especially in Latin America. The role of clinical laboratory is to provide useful, reliable and reproducible information to be used in clinical practice, regardless of the methodology used and the intervening laboratory. For this, quality was implemented to improve the systematic and random errors in the determinations of clinical laboratories. Standardization programs are launched in 2006.Moreover serum creatinine and creatinine clearance joined the clinic, to be arrived at a milestone that was the determination of the estimated Glomerular Filtration Rate (eGFR) from formulas (MDRD and CKD-EPI). The need for standardization of the determination of creatinine was established in the Guide 4 KDOQUI in 2002. Regarding the determination of serum creatinine for estimating eGFR, a long way has come: from identification of the concept of clearance, its application to the determination of renal function, its use in the clinic for diagnosis, progression and prognosis, identifying it as an epidemiological indicator in population risk setting. In this context the need for standardization is established
Asunto(s)
Humanos , Técnicas de Laboratorio Clínico , Creatinina , Tasa de Filtración Glomerular , Estándares de Referencia , Insuficiencia Renal CrónicaRESUMEN
Numerosos estudios han demostrado que los niveles plasmáticos de cistatina C tienen más exactitud que los de creatinina en la estimación de la tasa de filtración glomerular (eTFG). Sin embargo, no se utiliza como prueba rutinaria en el diagnóstico de patologías renales pediátricas. El objetivo de este estudio fue comparar la TFG para cistatina C en pacientes pediátricos mexicanos con y sin exposición a factores de riesgo para presentar Insuficiencia Renal Aguda (IRA) y corroborar las ventajas de emplear este marcador en el diagnóstico oportuno de patologías renales en relación con la creatinina. Se analizaron 106 muestras para estimar la TFG. Se cuantificó la concentración de creatinina y cistatina C, sustituyendo los valores en las fórmulas MDRD v-4 y Filler y Lepage, respectivamente. Se compararon las concentraciones tanto de creatinina como de cistatina entre los grupos de estudio por medio de U de Mann Whitney. Asimismo, se evaluó la correlación entre estos dos metabolitos divididos por presencia o no de factores de riesgo para presentar la enfermedad renal. Se observó una correlación entre las concentraciones de creatinina y cistatina C sérica, tanto en el grupo de pacientes sin factores de riesgo para IRA (r=0,936, p<0,001) como en los que sí presentaron factores de riesgo para IRA (r=0,952, p<0,001). El grupo con factores de riesgo mostró concentraciones mayores tanto de cistatina como de creatinina, así como de eTFG para ambos metabolitos. La cistatina C muestra una buena correlación con la creatinina. Por otro lado, la cistatina alterada identificó a un mayor número de pacientes con factores de riesgo para IRA, por lo cual se propone su uso como prueba de escrutinio en pacientes pediátricos.(AU)
Numerous studies have shown that plasma levels of cystatin C are more accurate than creatinine estimating the Glomerular Filtration Rate (eGFR), however they are not used as a routine test in the diagnosis of pediatric renal pathologies. The aim of this study was to determine GFR for cystatin C in Mexican pediatric patients exposed to risk factors of Acute Kidney Disease (AKD) compared to children without risk factors for AKD and corroborate the advantages of using this marker in the early diagnosis of kidney diseases in relation to creatinine. A total of 106 samples were analyzed to estimate the GFR. Creatinine and cystatin C concentration were quantified by substituting the values in the MDRD v-4 and Filler and Lepage formulas respectively. The concentrations of both creatinine and cystatin between the study groups were compared by Mann Whitney. Likewise, the correlation between these two metabolites divided by presence or absence of risk factors present in renal disease was assessed. A correlation between creatinine and serum cystatin C concentrations was observed in both groups of patients without risk factors of AKD (r=0.936, p<0.001) and in those who presented risk factors of AKD (r=0.952 , p<0.001). The risk factor group showed higher concentrations of cystatin and creatinine as well as eTFG for both metabolites. Cystatin C shows a good correlation with creatinine. Furthermore, altered cystatin identified a greater number of patients with risk factors of AKD and it is proposed as a screening test in pediatric patients.(AU)
Numerosos estudos tÛm demonstrado que os níveis plasmáticos de cistatina C sÒo mais exatos do que a creatinina para calcular a taxa de filtraþÒo glomerular (TFG). No entanto, nÒo é usado como teste de rotina no diagnóstico de patologias renais pediátricas. O objetivo deste estudo foi comparar a TFG para cistatina C em pacientes pediátricos mexicanos expostos ou nÒo a fatores de risco para apresentar InsuficiÛncia Renal Aguda (IRA) e comprovar as vantagens da utilizaþÒo deste marcador no diagnóstico oportuno de doenþas renais em relaþÒo O creatinina. 106 amostras foram analisadas para estimar a TFG. Foi quantificada a concentraþÒo em creatinina e cistatina C, substituindo os valores nas fórmulas MDRD v-4 e Filler e Lepage respectivamente. As concentraþ§es tanto de creatinina quanto de cistatina foram comparadas entre os grupos de estudo através do U de Mann Whitney. Do mesmo modo, foi avaliada a correlaþÒo entre estes dois metabólitos divididos por presenþa ou ausÛncia de fatores de risco para apresentar a doenþa renal. Foi observada uma correlaþÒo entre as concentraþ§es de creatinina e cistatina C sérica tanto no grupo de pacientes sem fatores de risco para IRA (r=0,936, p<0,001) quanto naqueles que sim apresentavam fatores de risco para IRA (r=0,952, p<0,001). O grupo com fatores de risco apresentou concentraþ§es mais elevadas tanto de cistatina como de creatinina, bem como de ETFG para ambos os metabólitos. A Cistatina C mostra uma boa correlaþÒo com a creatinina. Além disso, a cistatina alterada identificou maior número de pacientes com fatores de risco para IRA, pelo qual se prop§e sua utilizaþÒo como teste de triagem em pacientes pediátricos.(AU)
RESUMEN
BACKGROUND: There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers. OBJECTIVES: To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria. METHODS: We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR). RESULTS: eGFR varied by job and decreased during the harvest in seed cutters (-8·6 ml/min/1·73 m(2)), irrigators (-7·4 ml/min/1·73 m(2)), and cane cutters (-5·0 ml/min/1·73 m(2)), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g. CONCLUSIONS: The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.
Asunto(s)
Agricultores , Enfermedades Renales/epidemiología , Enfermedades Profesionales/epidemiología , Proteinuria/epidemiología , Saccharum , Adolescente , Adulto , Albuminuria , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Enfermedades Renales/sangre , Enfermedades Renales/fisiopatología , Enfermedades Renales/orina , Masculino , Persona de Mediana Edad , Nicaragua/epidemiología , Enfermedades Profesionales/sangre , Enfermedades Profesionales/fisiopatología , Enfermedades Profesionales/orina , Proteinuria/sangre , Proteinuria/fisiopatología , Proteinuria/orina , Adulto JovenRESUMEN
Correct interpretation of the urinary sodium concentration (NaU) and its relation to renal function in critically ill patients is lacking. Our aim was to evaluate the relationship between simultaneous NaU value and serum creatinine (sCr). The hypothesis is that a NaU value greater than 140 mmol/l (normal equivalent value in plasma) is only found in patients with normal sCr. We made a retrospective analysis of 1153 simultaneous samples of NaU and sCr, divided according to diuretic use in the previous 24 hours and grouped in five distinct NaU ranges (< 20, 20 to 39, 40 to 139, 140 to 169, ≥ 170 mmol/l). NaU values below 140 mmol/l were found simultaneously with both normal and increased sCr. NaU values above 140 mmol/l were almost always found in patients with normal sCr, even if diuretics were used. Median sCr values in the NaU ranges above 140 mmol/l were significantly lower than in the other NaU ranges. Estimated glomerular filtration rates were lower and intensive care unit and hospital mortalities were higher in patients with NaU values lower than 140 mmol/l compared to patients with a NaU higher than 140 mmol/l. We concluded that a high natriuretic capacity reflects significant residual renal function in the critically ill. NaU greater than normal plasma sodium is a possible biomarker of normal/improving renal function and also of better outcome. Sole NaU values below 140 mmol/l are difficult to interpret but it is possible that very low NaU values may signify some threat to normal kidney function and worse prognosis even in the presence of normal sCr. Our way to interpret NaU values in critically ill patients needs further careful evaluation.
Asunto(s)
Enfermedad Crítica , Sodio/sangre , Sodio/orina , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/fisiopatología , Adulto , Anciano , Biomarcadores , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Currently there are no serum creatinine reference values in Colombia for healthy dogs related to body weight; there are only available foreign studies. The objective was to determine serum creatinine values in healthy dogs related to body weight at the South Valley of Aburra. There were sampled 320 healthy dogs and divided into three groups related to the body weight according to the Kennel Club classification as follows: 1-10 kg, 11-25 kg and over 25 kg. In order to determine their health status, their medical records were revised and a complete physical examination was performed. Subsequently, a blood sample was taken to measure the creatinine levels. Statistically significant differences were found (p<0.05) among the three groups. This article presents evidence to classify serum creatinine values related to body weight in dogs, which could allow veterinarians to have a better reference value for assessing kidney function.
Actualmente no se cuenta con valores de referencia de creatinina sérica en Colombia en caninos sanos con relación al peso corporal. Solo se tienen los estudios foráneos. El objetivo central fue determinar los valores séricos de creatinina en perros sanos según el peso corporal en el sur del Valle de Aburrá. Se muestrearon 320 perros clínicamente sanos, los cuales se dividieron en tres grupos según el peso corporal de acuerdo con la clasificación del Kennel Club, 1-10 kg, 11-25 kg y mayores de 25 kg. Se realizó análisis de la historia clínica y un examen físico completo para determinar su estado de salud. Posteriormente, se tomó la muestra de sangre para la medición de creatinina. Se encontraron diferencias estadísticas significativas (p < 0,05) entre los tres grupos. Este artículo presenta evidencia para clasificar los valores de creatinina sérica según el peso corporal, lo que permite a los médicos veterinarios tener un mejor referente para la evaluación de la función renal.
A medição da creatinina sérica é um dos parâmetros atualmente utilizados na prática clínica pra avaliar a função renal em cães, isto é possível já que a creatinina é um componente do metabolismo muscular a qual é filtrada livremente pelos glomérulos, permitindo deste jeito estabelecer de forma geral a taxa de filtração glomerular e assim mesmo a da função renal. Atualmente não há valores de referência pra creatinina sérica na Colômbia em cães saudáveis em relação ao peso corporal, só ha estudos estrangeiros. Objetivo: Determinar os valores séricos de creatinina em cães saudáveis segundo seu peso corporal no Sul do Valle do Aburra. Foram amostrados 320 cães saudáveis, os quais foram divididos em três grupos, segundo o peso corporal de acordo com a classificação do Kennel Club, 1-10 kg, 11-25 kg e mais de 25 kg. Foi realizada a análise da história clínica e um exame físico completo para determinar seu estado de saúde; em seguida, tomou-se a amostra de sangue para a medição da creatinina. Foram encontradas diferenças estatisticamente significativas (p < 0,05) entre os três grupos. Este artigo apresenta evidências para classificar valores de creatinina sérica segundo o peso corporal, o que poderia permitir aos médicos veterinários ter uma melhor referência ao avaliar a função renal.