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Toscan M, de Araújo BF, Martini JC, Ravazio R, de Souza VC. Our estimates of neonatal radiation exposure fall short of reality. Eur J Pediatr 2024; 183:1911-1916. [PMID: 38334796 DOI: 10.1007/s00431-024-05466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
The purpose of this study is to evaluate radiation exposure in newborns undergoing imaging tests during the first 30 days of neonatal intensive care unit (NICU) hospitalization. A retrospective cohort study was conducted from November 2018 to April 2019 with newborns admitted to the NICU. Thermoluminescent dosimeters (TLD-100™) measured radiation emitted during imaging exams over 1 month, with a comparison between measured and estimated radiation. The cohort exhibited a median gestational age of 33.0 (31.0, 37.0) weeks, a median birth weight of 1840 (1272, 2748) g, and a median length of stay of 25.5 (11.7, 55.0) days. Eighty-four patients underwent 314 imaging tests, with an estimated radiation dose (ERD) per patient of 0.116 mSv and a measured radiation dose (MDR) of 0.158 mSv. ERD consistently underestimated MDR, with a mean difference of -0.043 mSv (-0.049 to -0.036) in the Bland-Altman analysis. The regression equation was as follows: difference MRD - ERD = -1.7 × (mean (MRD + ERD)) + 0.056. The mean estimated radiation dose per exam was 0.030 mSv, and the chest X-rays accounted for 63.26% of total exams. The median number of radiographic incidences per patient was 2 (1, 4), with 5 patients undergoing three or more exams in a single day. CONCLUSION Radiation exposure in these newborns was underestimated, emphasizing the need for awareness regarding associated risks and strict criteria for requesting radiological exams. Lung ultrasound is a radiation-free and effective option in managing respiratory diseases in newborns, reducing the reliance on chest X-rays. WHAT IS KNOWN • Radiation used in diagnostic exams is not risk-free. • Radiation risk is much higher in small Infants due to the exposure area and the prolonged expectance of life. WHAT IS NEW • Radiation exposure is underestimated in the neonatal population. • The study found a mean radiation exposure in neonates about 5% of the mean annual dose in the general population.
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Affiliation(s)
- Michelle Toscan
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil.
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil.
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Breno Fauth de Araújo
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Júlio César Martini
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafaela Ravazio
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós Graduação em Ciências da Computação, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vandréa Carla de Souza
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
- Programa de Pós Graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil
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da Silva Selistre L, Renard C, Bacchetta J, Goutagny MP, Hu J, Carla de Souza V, Bertrand Y, Dubourg L, Domenech C. Teenagers and young adults with a past of allogenic hematopoietic stem cell transplantation are at significant risk of chronic kidney disease. Pediatr Nephrol 2022; 37:1365-1375. [PMID: 34735600 DOI: 10.1007/s00467-021-05319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (aHSCT) remains the treatment of choice for some malignant hemopathies in children, albeit with the risk of long-term consequences, including chronic kidney disease (CKD). METHODS In our single tertiary referral center, we retrospectively assessed the long-term renal outcome in a cohort of children and adolescents who had undergone aHSCT for malignant hemopathies between 2003 and 2017. We distinguished glomerular and tubular dysfunctions and assessed the accuracy of the most common formula(s) to estimate glomerular filtration rate (GFR) during standard clinical follow-up. RESULTS Among the 166 patients who had received aHSCT, 61 underwent kidney functional assessment 1 to 10 years post-transplantation. Twenty-seven patients (44.3%) had a CKD with glomerular impairment, including 20 patients with a GFR < 90 mL/min/1.73 m2, and among these, 5 patients < 60 mL/min/1.73 m2. Patients with tubular signs had a significantly higher baseline GFR: 112 mL/min/1.73 m2 [100; 120] versus 102 [99.0; 112.5] for patients without kidney involvement, and 76 [61; 86] for patients with CKD (p < 0.01). Schwartz, CKiDU25, and EKFC formulas significantly overestimated mGFR, with a P30% ≤ 30%, which could lead to overlooking CKD diagnosis in this population. No patient reached kidney failure. CONCLUSIONS In conclusion, our study shows that CKD represents an important long-term sequela for children and adolescents who undergo aHSCT for malignant hemopathies, either with glomerular dysfunction or with the more insidious tubular dysfunction which could potentially impact growth. These patients could benefit from specialized long-term nephrology follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Luciano da Silva Selistre
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Cécile Renard
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Justine Bacchetta
- Centre de Référence Des Maladies Rénales Rares, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie-Pierre Goutagny
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Julie Hu
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
| | - Vandréa Carla de Souza
- Universidade de Caxias Do Sul, Programa de Pós Graduação Em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias Do Sul, Caxias do Sul, Brazil
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Carine Domenech
- Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Université Lyon 1, 1 place Professeur Joseph Renault, 69008, Lyon, France.
- Faculté de Médecine Et de Maïeutique Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052, CNRS 5286, Université Lyon 1, Lyon, France.
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Fonseca GDSD, Souza VCD, Bilibio SA, Carobin V, Facin L, Koch K, Machado M, Dubourg L, Selistre LDS. Performance of creatinine-based equations for estimating glomerular filtration rate compared to endogenous creatinine clearance. J Bras Nefrol 2021; 44:179-186. [PMID: 34874985 PMCID: PMC9269182 DOI: 10.1590/2175-8239-jbn-2021-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups. Methods: Cross-sectional study that evaluated the performance of four equations used for estimating GFR compared to endogenous creatinine clearance (ClCr) in 1,281 participants. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKD-EPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). We used the Quantile Regression to calculate the median bias, interquartile range (IQR), Bland-Altman agreement analysis and 30% margin of error (P30). Results: The mean age of participants was 52.5 ± 16.5 years with 466 women (38%), median ClCr[IQR] of 92.0 [58.0; 122.0] mL/min/1.73 m2, with 320 (25%) participants presenting ClCr < 60 mL/min/1.73 m2. The performance of the local CKD-EPI and FAS equations were superior to MDRD and CKD-EPI in relation to variability (0.92 [0.89; 0.94]) and P30 (90.5% [88.7; 92, 0]). In the group with ClCr < 60 mL/min/1.73 m2, the local CKD-EPI and FAS equations showed less variability than the CKD-EPI and MDRD (0.90 [0.86; 0.98] and 1.05 [0.97; 1.09] vs. 0.63 [0.61; 0.68] and 0.65 [0.62; 0.70], P < 0.01) and best P30 (85.5) % [81.0; 90.0], 88.0% [84.0; 92.0] vs. 52.0% (46.0; 58.0) and 53.0% [47.0; 58 .5], P < 0.01). Conclusion: Local CKD-EPI and FAS equations performed better than CKD-EPI and MDRD when compared to ClCr.
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Affiliation(s)
- Gisele da Silva da Fonseca
- Universidade de Caxias do Sul, Programa de Pós-Graduação em Ciências da Saúde Brasil, Caxias do Sul, RS, Brasil
| | - Vandréa Carla de Souza
- Universidade de Caxias do Sul, Programa de Pós-Graduação em Ciências da Saúde Brasil, Caxias do Sul, RS, Brasil.,Hospital Geral de Caxias do Sul, Caxias do Sul, RS, Brasil
| | | | | | - Lígia Facin
- Hospital Geral de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Ketelly Koch
- Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | | | | | - Luciano da Silva Selistre
- Universidade de Caxias do Sul, Programa de Pós-Graduação em Ciências da Saúde Brasil, Caxias do Sul, RS, Brasil.,Hospital Geral de Caxias do Sul, Caxias do Sul, RS, Brasil
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Selistre LDS, Lemoine S, Dantec A, Buron F, de Souza VC, Bertoldo M, Poli-de-Figueiredo CE, Rimmelé T, Thaunat O, Badet L, Morelon E, Sicard A, Dubourg L. Comparison of creatinine-based equations for estimating glomerular filtration rate in deceased donor renal transplant recipients. PLoS One 2020; 15:e0231873. [PMID: 32343691 PMCID: PMC7188287 DOI: 10.1371/journal.pone.0231873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Estimating glomerular filtration rate (GFR) is important for clinical management in kidney transplantation recipients (KTR). However, very few studies have evaluated the performance of the new GFR estimating equations (Lund-Malmö Revised-LMR, and Full Age Spectrum-FAS) in KTR. METHODS GFR was estimated (eGFR) using CKD-EPI, MDRD, LMR, and FAS equations and compared to GFR measurement (mGFR) by reference methods (inuline urinary and iohexol plasma clearance) in 395 deceased-donor KTR without corticosteroids. The equations performance was assessed using bias (mean difference of eGFR and mGFR), precision (standard deviation of the difference), accuracy (concordance correlation coefficient-CCC), and agreements (total deviation index-TDI). The area under receiver operating characteristic curves (ROC) and the likelihood ratio for a positive result were calculated. RESULTS In the total population, the performance of the CKD-EPI, MDRD and FAS equations was significantly lower than the LMR equation regarding the mean [95%CI] difference in bias (-2.0 [-4.0; -1.5] versus 9.0 [7.5; 10.0], 5.0 [3.5; 6.0] and 10.0 [8.5; 11.0] mL/min/1.73m2, P<0.005) and TDI (17.10 [16.41; 17.88], 25.91 [24.66; 27.16], 21.23 [19.48; 23.13] and 25.84 [24.16; 27.57], respectively). Concerning the CCC, all equation had poor agreement (<0.800) without statically difference between them. However, all equations had excellent area under the ROC curve (>0.900), and LMR equation had the best ability to correctly predict KTR with mGFR<45 mL/min/1.73 m2 (positive likelihood ratio: 8.87 [5.79; 13.52]). CONCLUSION Among a referral group of subjects KTR, LMR equation had the best mean bias and TDI, but with no significant superiority in other agreement tools. Caveat is required in the use and interpretation of PCr-based equations in this specific population.
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Affiliation(s)
- Luciano da Silva Selistre
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Universidade de Caxias do Sul—Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Sandrine Lemoine
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/Lyon 1, Lyon, France
| | - Allyriane Dantec
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Vandréa Carla de Souza
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Universidade de Caxias do Sul—Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil
- Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil
| | - Mariana Bertoldo
- Universidade de Caxias do Sul—Programa de Pós-Graduação em Ciências da Saúde, Caxias do Sul, Brazil
| | | | - Thomas Rimmelé
- CarMeN: Cardiovasculaire, Métabolisme, Diabétologie & Nutrition-INSERM U1060/Lyon 1, Lyon, France
- Service d'anesthésie-réanimation, hôpital Edouard-Herriot, Lyon, France
| | - Olivier Thaunat
- Université Lyon 1, Lyon, France
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Lionel Badet
- Université Lyon 1, Lyon, France
- Service d’Urologie et Transplantation, Hôpital Edouard Herriot, Lyon, France
| | - Emmanuel Morelon
- Université Lyon 1, Lyon, France
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Antoine Sicard
- Université Lyon 1, Lyon, France
- Unité INSERM U1111, Lyon, France
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Laboratoire de Biologie Tissulaire et d’ingénierie Thérapeutique (LBTI), UMR 5305 CNRS, Université Claude Bernard Lyon 1, Lyon, France
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Dantec A, Selistre L, Lemoine S, Buron F, de Souza VC, Rimmelé T, Thaunat O, Badet L, Morelon E, Dubourg L, Sicard A. Performances of creatinine-based glomerular filtration rate estimating equations in simultaneous pancreas-kidney transplant recipients: a single center cohort study. Transpl Int 2018; 32:75-83. [DOI: 10.1111/tri.13333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/11/2018] [Accepted: 08/11/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Allyriane Dantec
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
| | | | - Sandrine Lemoine
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Laboratoire CarMeN; INSERM 1060; Lyon France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
| | | | - Thomas Rimmelé
- Université Lyon 1; Lyon France
- Service d'anesthésie-réanimation; Hôpital Edouard-Herriot; Lyon France
| | - Olivier Thaunat
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Unité INSERM U1111; Lyon France
| | - Lionel Badet
- Université Lyon 1; Lyon France
- Service d'Urologie et Transplantation; Hôpital Edouard Herriot; Lyon France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- Unité INSERM U1111; Lyon France
| | - Laurence Dubourg
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
- UMR 5305 CNRS/UCBL; Biologie Tissulaire et Ingénierie Thérapeutique; Lyon France
| | - Antoine Sicard
- Service de Transplantation, Néphrologie et Immunologie Clinique; Hôpital Edouard Herriot; Lyon France
- Université Lyon 1; Lyon France
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Selistre LDS, Cochat P, Rech DL, Parant F, de Souza VC, Dubourg L. Association between glomerular filtration rate (measured by high-performance liquid chromatography with iohexol) and plasma oxalate. J Bras Nefrol 2018; 40:73-76. [PMID: 29738022 PMCID: PMC6533971 DOI: 10.1590/1678-4685-jbn-3743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). METHODS A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). CONCLUSION In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).
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Affiliation(s)
| | - Pierre Cochat
- Université Claude-Bernard Lyon, Centre de Référence des Maladies
Rénales Rares Nephrogones, Service de Néphrologie et Rhumatologie Pédiatriques,
Lyon, France
| | | | - François Parant
- Hospices Civils de Lyon, GHS - Centre de Biologie Sud, UM
Pharmacologie - Toxicologie, F-69495, Pierre Bénite, France
| | | | - Laurence Dubourg
- Université Claude-Bernard, Groupement Hospitalier Edouard Herriot,
Hospices Civils de Lyon, UMR 5305, Rhone-Alpes, Lyon, France
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Selistre LDS, Souza VCD, Dubourg L, Wagner MB, Hoefel Filho JR, Saitovitch D. Contrast-induced nephropathy after computed tomography. J Bras Nefrol 2017; 37:27-31. [PMID: 25923747 DOI: 10.5935/0101-2800.20150005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. OBJECTIVE We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. METHODS We studied 400 patients prospectively. RESULTS The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). CONCLUSIONS We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.
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de Souza VC, Rabilloud M, Cochat P, Wagner MB, Garcia CD, Ranchin B, Iwaz J, Selistre L, Dubourg L. Trajectories and Predictors of Allograft Dysfunction after Renal Transplantation in Children. Am J Nephrol 2016; 45:63-68. [PMID: 27894119 DOI: 10.1159/000453076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The survival rates of renal transplant children are indeed on the rise, but it is still important to ensure that there is optimal renal function in these children in all their future growing years. The number of functioning nephrons and the graft ability to adapt to an increasing demand during body growth seem to be the most important factors for long-term allograft function. This study examined the long-term change in the glomerular filtration rate in a pediatric kidney transplant cohort and the importance of the recipient and donor ages in predicting transplant outcome. METHODS Data on 67 renal transplant children who underwent 278 inulin-clearance measurements between 2000 and 2010 were examined. A longitudinal latent class model was used to identify renal function trajectories and classify the children. RESULTS This model identified 3 trajectories of renal allograft function after pediatric kidney transplantation: 'low and decreasing', 'moderate and stable', and 'high and sharply decreasing'. The probability of belonging to the low and decreasing trajectory - that is, the poorer outcome - was lower in recipients of grafts from living versus deceased donor (adjusted OR (aOR) 0.02; p = 0.03). This probability increased with recipient age (aOR 1.20 per year of recipient ageing; p = 0.07) and donor-recipient age-difference (aOR 1.13 per additional year; p = 0.07). CONCLUSION This study suggests that donation from living donors and from younger donors are favorable factors for long-term allograft function.
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