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Kirsztajn GM, da Silva GB, da Silva AQB, Abensur H, Romão JE, Bastos MG, Calice-Silva V, do Carmo LPDF, de Sandes-Freitas TV, Abreu PF, Andreguetto BD, Cortes LGF, Oliveira MGDL, Vieira LMF, Moura-Neto JA, Andriolo A. Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML). J Bras Nefrol 2024; 46:e20230193. [PMID: 38591823 PMCID: PMC11300030 DOI: 10.1590/2175-8239-jbn-2023-0193en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 02/07/2024] [Indexed: 04/10/2024] Open
Abstract
Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.
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Affiliation(s)
- Gianna Mastroianni Kirsztajn
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São
Paulo, SP, Brazil
| | - Geraldo Bezerra da Silva
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade de Fortaleza, Centro de Ciências da Saúde, Programas de
Pós-Graduação em Ciências Médicas e Saúde Coletiva, Fortaleza, CE, Brazil
| | - Artur Quintiliano Bezerra da Silva
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade Federal do Rio Grande do Norte, Departamento de
Medicina Integrada, Natal, RN, Brazil
| | - Hugo Abensur
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP,
Brazil
| | - João Egídio Romão
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP,
Brazil
| | - Marcus Gomes Bastos
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de
Fora, MG, Brazil
- Faculdade Ubaense Ozanam Coelho, Ubá, MG, Brazil
| | - Viviane Calice-Silva
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade da Região de Joinville, Joinville, SC, Brazil
- Fundação Pró-Rim, Joinville, SC, Brazil
| | - Lilian Pires de Freitas do Carmo
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo
Horizonte, MG, Brazil
| | - Tainá Veras de Sandes-Freitas
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza,
CE, Brazil
| | - Patrícia Ferreira Abreu
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São
Paulo, SP, Brazil
| | | | - Luiz Gustavo Ferreira Cortes
- Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial,
Rio de Janeiro, RJ, Brazil
- Hospital Israelita Albert Einstein, Laboratório Clínico, São Paulo,
SP, Brazil
| | | | - Luisane Maria Falci Vieira
- Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial,
Rio de Janeiro, RJ, Brazil
- Dasa – Diagnósticos da América S.A., São Paulo, SP, Brazil
| | - José A. Moura-Neto
- Sociedade Brasileira de Nefrologia, São Paulo, SP, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA,
Brazil
| | - Adagmar Andriolo
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São
Paulo, SP, Brazil
- Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial,
Rio de Janeiro, RJ, Brazil
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Attalla M, Friedman Z, McKeown S, Harel Z, Hingwala J, Molnar AO, Norman P, Silver SA. Characteristics and Effectiveness of Dedicated Care Programs for Patients Starting Dialysis: A Systematic Review. KIDNEY360 2020; 1:1244-1253. [PMID: 35372876 PMCID: PMC8815511 DOI: 10.34067/kid.0004052020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/08/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Dedicated care programs that provide increased support to patients starting dialysis are increasingly being used to reduce the risk of complications. The objectives of this systematic review were to determine the characteristics of existing programs and their effect on patient outcomes. METHODS We searched Embase, MEDLINE, Web of Science, Cochrane CENTRAL, and CINAHL from database inception to November 20, 2019 for English-language studies that evaluated dedicated care programs for adults starting maintenance dialysis in the inpatient or outpatient setting. Any study design was eligible, but we required the presence of a control group and prespecified patient outcomes. We extracted data describing the nature of the interventions, their components, and the reported benefits. RESULTS The literature search yielded 12,681 studies. We evaluated 66 full texts and included 11 studies (n=6812 intervention patients); eight of the studies evaluated hemodialysis programs. All studies were observational, and there were no randomized controlled trials. The most common interventions included patient education (n=11) and case management (n=5), with nurses involved in nine programs. The most common outcomes were mortality (n=8) and vascular access (n=4), with only three studies reporting on the uptake of home dialysis and none on transplantation. We identified four high-quality studies that combined patient education and case management; in these programs, the relative reduction in 90-day mortality ranged from 22% (95% CI, -3% to 41%) to 49% (95% CI, 33% to 61%). Pooled analysis was not possible due to study heterogeneity. CONCLUSIONS Few studies have evaluated dedicated care programs for patients starting dialysis, especially their effect on home dialysis and transplantation. Whereas multidisciplinary care models that combine patient education with case management appear to be promising, additional prospective studies that involve patients in their design and execution are needed before widespread implementation of these resource-intensive programs.
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Affiliation(s)
- Mirna Attalla
- Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Canada
| | - Zoe Friedman
- Department of Biology, Queen’s University, Kingston, Canada
| | - Sandra McKeown
- Health Sciences Library, Queen’s University, Kingston, Canada
| | - Ziv Harel
- Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Jay Hingwala
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Amber O. Molnar
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Patrick Norman
- Kingston General Health Research Institute, Kingston, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
| | - Samuel A. Silver
- Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Canada
- Kingston General Health Research Institute, Kingston, Canada
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Tavares APDS, Santos CGDS, Tzanno-Martins C, Barros Neto J, Silva AMMD, Lotaif L, Souza JVL. Kidney supportive care: an update of the current state of the art of palliative care in CKD patients. ACTA ACUST UNITED AC 2020; 43:74-87. [PMID: 32897286 PMCID: PMC8061961 DOI: 10.1590/2175-8239-jbn-2020-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022]
Abstract
Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.
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Affiliation(s)
- Alze Pereira Dos Santos Tavares
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Hospital Santa Paula, São Paulo, SP, Brasil
| | - Cássia Gomes da Silveira Santos
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Universidade Federal do Paraná, Hospital das Clínicas, Curitiba, PR, Brasil
| | - Carmen Tzanno-Martins
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Clínica de Hemodiálise, São Paulo, SP, Brasil
| | - José Barros Neto
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Sociedade Brasileira de Nefrologia Mineira, Belo Horizonte, MG, Brasil.,Felício Rocho Hospital, Departamento de Nefrologia, Belo Horizonte, MG, Brasil
| | | | - Leda Lotaif
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Instituto Dante Pazzanese de Cardiologia, Nefrologia e Hipertensão e Pós-Graduação, São Paulo, SP, Brasil.,HCor, São Paulo, SP, Brasil
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Rai PK, Rai P, Bhat RG, Bedi S. Chronic Kidney Disease among Middle-Aged and Elderly Population: A cross-sectional screening in a Hospital Camp in Varanasi, India. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 30:795-802. [PMID: 31464235 DOI: 10.4103/1319-2442.265454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic kidney disease (CKD) is no longer considered just a health burden, but a major health priority owing to its high treatment costs and poor outcome. The lack of community-based screening programs has led to the detection of CKD patients at advanced stages. This study aims to estimate the prevalence of CKD and patterns of known risk factors among the general population (middle-aged and elderly) attending a screening camp in a community-based setting. The study participants constituted a part of the general population of Varanasi (aged ≥45 years) who volunteered in a screening camp that was organized as part of the World Kidney Day Initiative at Opal Hospital. Information on age, sex, height, weight, smoking and drug history, history of diabetes, hypertension, and family history of kidney disease was extensively interrogated, while laboratory investigations such as urinalysis and serum creatinine levels were recorded. More than three-fifths of the participants were middle-aged adults (i.e., 45-64 years) and the remaining 34.8% were elderly population, i.e., ≥65 years. The overall prevalence of CKD in the 198 studied participants was 29.3%. Higher number of participants (40.6%) of elderly population had CKD (P = 0.011). The serum creatinine, albuminuria, and estimated glomerular filtration rate levels were strongly associated with CKD (P <0.05). Our study suggests that elderly individuals are at risk with higher serum creatinine levels and would benefit from early detection of CKD to prevent disease progression and associated morbidity and mortality.
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Affiliation(s)
- Pradeep Kumar Rai
- Department of Nephrology, Opal Hospital, Varanasi, Uttar Pradesh, India
| | - Punam Rai
- Department of Clinical Physiology, Opal Hospital, Varanasi, Uttar Pradesh, India
| | - Rasika Ganpathi Bhat
- Department of Medical Genetics, College of Nursing, Bombay Hospital and Research Center, Mumbai, Maharashtra, India
| | - Sonam Bedi
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Wei H, Yan Y, Gong J, Dong J. Prevalence of kidney damage in Chinese elderly: a large-scale population-based study. BMC Nephrol 2019; 20:341. [PMID: 31477037 PMCID: PMC6719360 DOI: 10.1186/s12882-019-1525-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In China, both population aging and kidney damage has become emerging public health challenges. Despite the number of elders is huge, data on kidney damage in this population are scarce. The present study aimed to describe the prevalence of kidney damage among older adults in Wuhan, China. METHODS To describe the prevalence of kidney damage among Chinese elderly, the health screening data of 350,881 adults older than 65 years in Wuhan, China were collected and analyzed. Kidney damage was defined as eGFR less than 60 mL/min per 1·73 m2 or the presence of proteinuria. Decreased renal function was defined as an eGFR < 60 mL/min/1.73 m2. Proteinuria was defined as urine protein ≥1+ and without urine WBC or nitrite positive. The associated risk factors of eGFR decline and kidney damage were analyzed by multivariate logistic regression. RESULTS The age-standardized prevalence of kidney damage, decreased renal function and proteinuria was 17.2, 13.5 and 5.3%. Among the patients, up to 74.4% was stage 3. The prevalence of kidney damage and eGFR decline were higher in suburbs than in urban (18.3% vs 16.0 and 14.6% vs 12.4%). Factors independently associated with kidney damage were age, female, BMI, abdominal circumference, hypertension, diabetes, stroke and coronary heart disease. CONCLUSIONS Kidney damage has become an important public health problem in Chinese elderly. More attention should be paid to elderly lived in suburbs or rural area in our further work.
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Affiliation(s)
- Honglan Wei
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430033 People’s Republic of China
| | - Yaqiong Yan
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei 430000 People’s Republic of China
| | - Jie Gong
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei 430000 People’s Republic of China
| | - Junwu Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430033 People’s Republic of China
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Asserraji M, Bouzerda A, Soukrate S, Maoujoud O, Belarbi M, Zemraoui N, Bendriss L, Khatouri A. Usefulness of ambulatory blood pressure monitoring in chronic kidney disease: The moroccan experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:913-918. [PMID: 31464249 DOI: 10.4103/1319-2442.265468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Among patients with chronic kidney disease (CKD), hypertension (HTN) is very common and widely recognized to accelerate the progression of CKD and increase the risk for cardiovascular events. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting HTN than office blood pressure (BP) measurement. The goal of this study is to describe the ABPM characteristics in a group of CKD and hypertensive patients. A transversal study was conducted over a period of six months, to evaluate the ABPM patterns among a group of hypertensive patients with CKD (Group 1) and compared the data with a control group (Group 2). ABPM was performed with measurement rate every 15 min during daytime and 30 min at night. Nondipping BP patterns were defined as the absence of fall in nocturnal systolic and diastolic BP >10% of daytime values. Masked HTN was defined as controlled office BP (<140/90 mm Hg) with an elevated overall average BP by 24-h ABPM (>125/75 mm Hg), and white-coat HTN was defined as association of elevated BP readings (>140/90 mm Hg) in a clinical setting and normal 24-h average BP levels (<130/80 mm Hg). Fifty patients were included in each group. HTN was much longer in duration among hypertensive patients with CKD and frequently associated with obesity, dyslipidemia, and diabetes (64% vs. 39.60%). Positive proteinuria was present in 82% of CKD patients with HTN. CKD patients with HTN received more antihypertensive drugs than Group 2 patients. HTN was much more uncontrolled among CKD patients (60% vs. 24%), more serious with higher daytime and nighttime SBP, and loss of physiologic dipping during nighttime BP measurement (80%). Out-of-office BP monitoring by ABPM may improve the assessment and the successful management of HTN in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat HTN would facilitate research.
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Affiliation(s)
- Mohammed Asserraji
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | - Safia Soukrate
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
| | - Omar Maoujoud
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Merouane Belarbi
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Nadir Zemraoui
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Leila Bendriss
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
| | - Ali Khatouri
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
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Abstract
The years of life lost and years lived with disability resulting from chronic kidney disease (CKD) increased globally by 90% and 49.5%, respectively, between 1990 and 2013. In addition to the traditional factors, infections, low birthweight, environmental factors, and low socioeconomic status contribute to the CKD burden in low- and middle-income countries. System-level challenges such as poor appreciation of the burden, insufficient human resources, high health care costs, poor referral pathways, unreliable health information systems, and inadequate medicine supply pose barriers to CKD control. In this article, we present evidence that the CKD burden in low- and middle-income countries is related to system-wide issues, which could be reduced effectively using innovative, affordable, and scalable interventions. A multipronged approach is required including improving socioeconomic determinants of health, enabling the environment for healthy decision making, and sustainable interventions. Innovative approaches include promoting healthy behaviors, counseling, and education in primary care, task-sharing between physicians and nonphysicians, using technology to train nonphysicians to screen, diagnose, refer, follow-up, and educate patients, and ensuring quality. Stronger political will and system-level change are needed to prevent and manage CKD if the sustainable development goals of reducing premature mortality from noncommunicable diseases by 2030 are to be attained.
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Affiliation(s)
- Rohina Joshi
- The George Institute for Global Health, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Oommen John
- The George Institute for Global Health India, New Delhi, India
| | - Vivekanand Jha
- The George Institute for Global Health India, New Delhi, India; Department of Nephrology, University of Oxford, Oxford, United Kingdom.
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8
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Diminished stress resistance and defective adaptive homeostasis in age-related diseases. Clin Sci (Lond) 2017; 131:2573-2599. [PMID: 29070521 DOI: 10.1042/cs20160982] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 09/15/2017] [Indexed: 02/06/2023]
Abstract
Adaptive homeostasis is defined as the transient expansion or contraction of the homeostatic range following exposure to subtoxic, non-damaging, signaling molecules or events, or the removal or cessation of such molecules or events (Mol. Aspects Med. (2016) 49, 1-7). Adaptive homeostasis allows us to transiently adapt (and then de-adapt) to fluctuating levels of internal and external stressors. The ability to cope with transient changes in internal and external environmental stress, however, diminishes with age. Declining adaptive homeostasis may make older people more susceptible to many diseases. Chronic oxidative stress and defective protein homeostasis (proteostasis) are two major factors associated with the etiology of age-related disorders. In the present paper, we review the contribution of impaired responses to oxidative stress and defective adaptive homeostasis in the development of age-associated diseases.
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Wang XX, Luo Y, Wang D, Adorini L, Pruzanski M, Dobrinskikh E, Levi M. A dual agonist of farnesoid X receptor (FXR) and the G protein-coupled receptor TGR5, INT-767, reverses age-related kidney disease in mice. J Biol Chem 2017; 292:12018-12024. [PMID: 28596381 DOI: 10.1074/jbc.c117.794982] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/07/2017] [Indexed: 11/06/2022] Open
Abstract
Even in healthy individuals, renal function gradually declines during aging. However, an observed variation in the rate of this decline has raised the possibility of slowing or delaying age-related kidney disease. One of the most successful interventional measures that slows down and delays age-related kidney disease is caloric restriction. We undertook the present studies to search for potential factors that are regulated by caloric restriction and act as caloric restriction mimetics. Based on our prior studies with the bile acid-activated nuclear hormone receptor farnesoid X receptor (FXR) and G protein-coupled membrane receptor TGR5 that demonstrated beneficial effects of FXR and TGR5 activation in the kidney, we reasoned that FXR and TGR5 could be excellent candidates. We therefore determined the effects of aging and caloric restriction on the expression of FXR and TGR5 in the kidney. We found that FXR and TGR5 expression levels are decreased in the aging kidney and that caloric restriction prevents these age-related decreases. Interestingly, in long-lived Ames dwarf mice, renal FXR and TGR5 expression levels were also increased. A 2-month treatment of 22-month-old C57BL/6J mice with the FXR-TGR5 dual agonist INT-767 induced caloric restriction-like effects and reversed age-related increases in proteinuria, podocyte injury, fibronectin accumulation, TGF-β expression, and, most notably, age-related impairments in mitochondrial biogenesis and mitochondrial function. Furthermore, in podocytes cultured in serum obtained from old mice, INT-767 prevented the increases in the proinflammatory markers TNF-α, toll-like receptor 2 (TLR2), and TLR4. In summary, our results indicate that FXR and TGR5 may play an important role in modulation of age-related kidney disease.
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Affiliation(s)
- Xiaoxin X Wang
- Division of Renal Diseases and Hypertension, Department of Medicine, Denver Veterans Affairs Medical Center and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Yuhuan Luo
- Division of Renal Diseases and Hypertension, Department of Medicine, Denver Veterans Affairs Medical Center and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Dong Wang
- Division of Renal Diseases and Hypertension, Department of Medicine, Denver Veterans Affairs Medical Center and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | | | | | - Evgenia Dobrinskikh
- Division of Renal Diseases and Hypertension, Department of Medicine, Denver Veterans Affairs Medical Center and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Moshe Levi
- Division of Renal Diseases and Hypertension, Department of Medicine, Denver Veterans Affairs Medical Center and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045.
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Furuta I, Zhai T, Umazume T, Ishikawa S, Nakagawa K, Kojima T, Yamada T, Morikawa M, Minakami H. Effects of childbirth on podocyturia in women with normotensive, uncomplicated pregnancies. Am J Physiol Renal Physiol 2017; 312:F1112-F1119. [PMID: 28274928 DOI: 10.1152/ajprenal.00623.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022] Open
Abstract
Changes in hemodynamics and blood pressure occur shortly before and after childbirth regardless of the mode of delivery. This study aimed to test the hypothesis that parturition induces a temporal increase in podocyturia monitored by podocyte-specific protein podocin mRNA expression levels (Pod-mRNA). A total of 105 urine specimens, consisting of 43 and 62 from 18 and 20 otherwise healthy women with vaginal delivery (VD) and elective cesarean delivery (ECS), respectively, were studied. Determination of urine protein and creatinine (Cr) concentrations and quantitative analyses of Pod-mRNA, nephrin mRNA (Nep-mRNA), synaptopodin mRNA (Syn-mRNA), and aquaporin 2 mRNA expression were performed using RT-PCR in pelleted urine samples. Levels of mRNA expression were corrected by urine Cr concentration. Podocyturia increased significantly, concomitant with a significantly decreased Nep:Pod-mRNA ratio (NPR) in the urine, collected immediately before or after childbirth regardless of the delivery mode compared with urine collected before commencement of labor or on postpartum day 3 or later. Podocyturia was significantly negatively correlated with NPR [correlation coefficient (r) = -0.614/-0.750 for VD/ECS women, respectively], as well as the Syn:Pod-mRNA ratio. Systolic blood pressure exceeded 140 mmHg during labor in 50% of VD women, and mean arterial pressure was significantly positively correlated with podocyturia during labor in VD women (r = 0.733). Thus parturition induces a transient increase in urine podocytes with reduced Nep- and Syn-mRNA expressions. Glomerular podocytes with reduced Nep- and Syn-mRNA levels were suggested to be likely to detach from the glomerular basement membrane around childbirth.
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Affiliation(s)
- Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Tianyue Zhai
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Umazume
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kinuko Nakagawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takashi Kojima
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Biljak VR, Honović L, Matica J, Krešić B, Vojak SŠ. The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations. Biochem Med (Zagreb) 2017; 27:153-176. [PMID: 28392738 PMCID: PMC5382859 DOI: 10.11613/bm.2017.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 12/08/2016] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is a common clinical condition with significant adverse consequences for the patient and it is recognized as a significant public health problem. The role of laboratory medicine in diagnosis and management of CKD is of great importance: the diagnosis and staging are based on estimation of glomerular filtration rate (eGFR) and assessment of albuminuria (or proteinuria). Therefore, the joint working group of the Croatian society of medical biochemistry and laboratory medicine and Croatian chamber of medical biochemists for laboratory diagnostics in CKD issued this national recommendation regarding laboratory diagnostics of CKD.
Key factors for laboratories implementing the national guidelines for the diagnosis and management of CKD are:
1. Ensure good communication between laboratory professionals and clinicians, such as nephrologists or specialists in general/family medicine,
2. Ensure all patients are provided with the same availability of laboratory diagnostics,
3. Ensure creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision,
4. Select the appropriate GFR estimating formula. Recommended equation is the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD - EPI) equation,
5. In reporting the key laboratory tests (creatinine, eGFR, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio) use the appropriate reporting units,
6. Provide adequate information on limitations of creatinine measurement.
The manuscript has been organized to identify critical points in laboratory tests used in basic laboratory diagnostics of CKD and is based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
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Affiliation(s)
- Vanja Radišić Biljak
- Department of medical biochemistry and laboratory medicine, Merkur University Hospital, Zagreb, Croatia
| | - Lorena Honović
- Department of medical biochemistry and laboratory medicine, General Hospital Pula, Pula, Croatia
| | - Jasminka Matica
- Medical-biochemistry laboratory, Primary care center of the Primorje-Gorski Kotar County, Rijeka, Croatia
| | - Branka Krešić
- Department of medical laboratory diagnostics, University Hospital Centre Split, Split, Croatia
| | - Sanela Šimić Vojak
- Department of laboratory diagnostics, General County Hospital Požega, Požega, Croatia
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12
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Furuta I, Zhai T, Ishikawa S, Umazume T, Nakagawa K, Yamada T, Morikawa M, Minakami H. Association between nephrinuria, podocyturia, and proteinuria in women with pre-eclampsia. J Obstet Gynaecol Res 2016; 43:34-41. [DOI: 10.1111/jog.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/26/2016] [Accepted: 08/21/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Itsuko Furuta
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Tianyue Zhai
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Satoshi Ishikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takeshi Umazume
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Kinuko Nakagawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takahiro Yamada
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Mamoru Morikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
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13
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Zhai T, Furuta I, Akaishi R, Ishikawa S, Morikawa M, Yamada T, Koyama T, Minakami H. Alteration of podocyte phenotype in the urine of women with preeclampsia. Sci Rep 2016; 6:24258. [PMID: 27052160 PMCID: PMC4823657 DOI: 10.1038/srep24258] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
Abstract
Podocyte injury has been suggested to induce phenotypic alteration of glomerular podocytes and accelerate the detachment of podocytes from the glomeruli resulting in podocyturia. However, it is not clear whether podocyte phenotypic alteration occurs in the urine of women with preeclampsia (PE). Seventy-seven and 116 pelleted urine samples from 38 and 18 women at various stages of normal and PE pregnancies, respectively underwent quantitative analysis of podocyte-specific or associated protein mRNA expression, including podocin, nephrin, and synaptopodin using RT-PCR. Significant proteinuria in pregnancy (SPIP) is defined as protein:creatinine ratio (P/Cr, mg/mg) ≥0.27 in the urine supernatant. All three urine-pellet mRNAs expression levels were significantly positively correlated with P/Cr levels, suggesting that podocyturia increased with proteinuria. The podocin:nephrin mRNA ratio (PNR) and synaptopodin:nephrin mRNA ratio (SNR) increased significantly with increasing P/Cr, while the podocin:synaptopodin mRNA ratio (PSR) did not change significantly according to P/Cr, resulting in significantly higher PNR and SNR, but not PSR levels, in urine from PE women with than without SPIP. The PNR, SNR, and PSR in urine from PE women before onset of SPIP were comparable to those from controls. Thus, nephrin mRNA expression was reduced in the podocytes recovered from PE women.
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Affiliation(s)
- Tianyue Zhai
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Rina Akaishi
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takahiro Koyama
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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14
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Zeng Q, Li P, Cai Y, Zhou W, Wang H, Luo J, Ding J, Chen H. Detection of creatinine in exhaled breath of humans with chronic kidney disease by extractive electrospray ionization mass spectrometry. J Breath Res 2016; 10:016008. [DOI: 10.1088/1752-7155/10/1/016008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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15
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Predictors of a Rapid Decline of Renal Function in Patients with Chronic Kidney Disease Referred to a Nephrology Outpatient Clinic: A Longitudinal Study. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/657624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Predicting the progression of kidney failure in patients with chronic kidney disease is difficult. The aim of this study was to assess the predictors of rapid kidney decline in a cohort of patients referred to a single outpatient nephrology clinic. Design. Longitudinal, prospective cohort study with a median follow-up of 3.39 years. Methods. Data were obtained from 306 patients with chronic renal failure based on serum creatinine-estimated glomerular filtration rate (eGFRcreat) < 90 mL/min/1.73 m2. After excluding patients who died (n=30) and those who developed end-stage renal failure (n=6), 270 patients were included. This population was grouped according to the rate of kidney function decline. Rapid kidney function decline was defined as an annual eGFRcreat loss > 4 mL/min/1.73 m2. We recorded nonfatal cardiovascular events at baseline and during follow-up in addition to biochemical parameters. Results. The mean loss in renal function was 1.22 mL/min/1.73 m2 per year. The mean age was 75 ± 8.8 years old, and the mean baseline eGFRcreat was 42 ± 14 mL/min/1.73 m2. Almost one-fourth of the sample (23.3% [63 patients]) suffered a rapid decline in renal function. In a logistic regression model with rapid decline as the outcome, baseline characteristics, lower serum albumin (OR: 0.313, 95% CI: 0.114–0.859), previous cardiovascular disease (OR: 1.903 95% CI: 1.028–3.523), and higher proteinuria (g/24 h) (OR: 1.817 CI 95%: 1.213–2.723) were the main predictors of rapid kidney decline. On multivariate analysis, including baseline and follow-up data, we obtained similar adjusted associations of rapid kidney decline with baseline serum albumin and proteinuria. The follow-up time was also shorter in the group with rapid rates of decline in renal function. Conclusion. Renal function remained stable in the majority of our population. Previous cardiovascular disease and cardiovascular incidents, lower serum albumin, and higher proteinuria at baseline were the main predictors of rapid kidney decline in our population.
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16
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Wakasugi M, Kazama JJ, Narita I. Anticipated increase in the number of patients who require dialysis treatment among the aging population of Japan. Ther Apher Dial 2014; 19:201-6. [PMID: 25545737 DOI: 10.1111/1744-9987.12266] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aging population is anticipated to have a large impact on the number of incident dialysis patients, as the risk of end-stage kidney disease increases with age. This study aimed to examine trends in the sex- and age-specific incidence rates of dialysis between 2008 and 2012, and to assess the impact of population aging on the number of incident dialysis patients over the next decade in Japan. Incidence was calculated using published data and Japan's population statistics. The 2012 incidence was extrapolated, and projected future demographic changes within the Japanese population were used to estimate the number of incident dialysis patients in 2020 and 2025. As a general trend, the sex- and age-specific incidence rates of dialysis decreased gradually between 2008 and 2012, except among men aged ≥80 years. The total number of incident dialysis patients was projected to increase by 12.8% from 36 590 in 2012 to 41 270 in 2025. Greater increases were observed in the oldest age group (≥85 years). In 2025, the number of incident dialysis patients in this group was projected to increase by 92.6% in men and 62.2% in women. This study shows the number of patients who initiate dialysis treatment is projected to increase over the next decade in Japan due to aging of the population. Effective strategies are needed to offset the challenges faced by the aging population, with a particular focus on octogenarians and older, given the notable proportion of patients requiring dialysis treatment in the future.
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Affiliation(s)
- Minako Wakasugi
- Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Junichiro James Kazama
- Division of Blood Purification Therapy, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
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17
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Ponticelli C, Podestà MA, Graziani G. Renal transplantation in elderly patients. How to select the candidates to the waiting list? Transplant Rev (Orlando) 2014; 28:188-92. [PMID: 25154797 DOI: 10.1016/j.trre.2014.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
Abstract
Today, old age does not represent a formal contraindication to kidney transplantation. Rather, there is evidence that in elderly patients renal transplantation offers longer life expectancy and better quality of life in comparison with dialysis. Yet, the results of renal transplantation in recipients older than 65years are inferior to those observed in younger adults, death with functioning graft representing a major cause of failure. Therefore, the selection of aged patients is of paramount importance. Apart from the routine clinical and biological investigations, three aspects have been relatively neglected by the transplant community and may require a careful analysis in elderly candidates to transplantation: the presence and degree of frailty, the presence of comorbidities and the adherence to prescriptions. Although there are rapid and simple tests for assessing the degree of frailty in the elderly, there is no clear cut-off value to decide whether a patient should be accepted or not. With advanced age the prevalence and severity of cardiovascular events and other diseases tend to increase. The use of combined age-comorbidity indices may be helpful to identify patients at high risk of mortality. Another critical point is the poor unintentional adherence to treatment, often caused by forgetfulness and mild cognitive impairment. These drawbacks may be further enhanced by a high number of pills to take and by changes in the dosage or type of prescriptions. A careful screening of the presence and degree of frailty, comorbidity and poor compliance to treatment is highly recommended before admitting older candidates to the waiting list for transplantation.
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Affiliation(s)
- Claudio Ponticelli
- Nephrology and Dialysis unit, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano (Milano), Italy.
| | - Manuel Alfredo Podestà
- Nephrology and Dialysis unit, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano (Milano), Italy
| | - Giorgio Graziani
- Nephrology and Dialysis unit, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano (Milano), Italy
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