Kidney function
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... Contents -- SECTION T STRUCTURE AND FUNCTION OF THE KIDNEYS AND THEIR CLINICAL ASSESSMENT, 1 -- 1 Overview ... ... of Kidney Function and Structure, 2 -- |osephine I“. ... ... -- SECTION 5 ACUTE KIDNEY INJURY, 287 -- 32 Pathophysiology of Acute Kidney Injury, 288 -- Stishnil ... ... Perazella | Anushree Shirali -- 38 Principles of Drug Therapy in Patients with Reduced Kidney Function ... ... Bone Disorders in Chronic Kidney Disease, 476 -- I Darryl Quarles -- 56 Cardiac Function and Cardiovascular ...
6th ed. xvii, 646 s. : il. ; 28 cm
Klíčem k diagnóze a léčbě chronických onemocnění ledvin je přesné stanovení funkce ledvin. Z funkčních vyšetřovacích metod se nejvíce osvědčilo vyšetřování glomerulární filtrace (GF). Renální funkce jsou mezi mnoha dalšími faktory závislé i na množství aktivní tělesné hmoty. Dosud navržené vzorce k určování renálních funkcí na základě sérové koncentrace kreatininu, které korigují tuto hodnotu na věk a tělesnou hmotnost, případně na tělesný povrch, nejsou přesné. Jednou z nových možností posouzení funkce ledvin by mohla být bioimpedanční analýza (BIA), což je neinvazivní a pacienta nezatěžuící metoda založena na ohmově zákonu. Její princip spočívá v tom, že tukuprostá hmota (ATH) obsahující vysoký podíl vody a elektrolytů je dobrým vodičem proudu, zatímco tuková tkáň se chová jako izolátor a špatný vodič. Pokles funkcí ledvin je spojen se změnou tělesného složení, které provází i úbytek aktivní tělesné hmoty. Protože ATH, charakterizována množstvím intra- i extracelulárních elektrolytů, je v přímém vztahu k hodnotám bioimpedance (Z), domníváme se, že změny (Z) budou lépe vyjadřovat případný pokles renálních funkcí než samotná tělesná hmotnost (TH), se kterou počítá většina vztahů pro nepřímé určení glomerulární funkce (GF). Proto jsme se pokusili vytvořit vztah pro výpočet renální funkce, který by hodnotu sérové koncentrace kreatininu korigoval na hodnotu impedance. Vztah byl vytvořen víceparametrickou regresí na souboru čtyřiceti osob z naměřených hodnot impedance a stanovené koncentrace sérového kreatininu. Výsledky naší studie je třeba dále standardizovat pomocí přesnější metody stanovení funkce ledvin např. inulin, iohexol nebo izotopové metody. Při dobré korelaci by to znamenalo zjednodušení stávajícího způsobu stanovení funkce ledvin.
Accurate kidney function evaluation is the key to diagnosis and treatment of chronic kidney diseases. Of the functional assessm ent methods, glomerular filtration (GF) measurement has proven most useful. Kidney functions are dependent, among many other factor s, also on the magnitude of active body mass. The suggested formulae for for kidney function assessment, based on serum creatinine concentration, corrected for age and body weight, or body surface, are not precise. Bioimpedance analysis (BIA), a non-invasive and non-stressing method based on the Ohm’s law, may be a new alternative. The unde r- lying principle is that the fat-free mass (FFM), with high content of water and electrolytes, is an effective current conductor , whereas the fat tissue acts as an insulator and bad conductor. The decline of kidney functions is related to the changes in tissue comp osition, including the loss of active body mass. As FFM, characterized by the ammount of intra- as well as extracellular electrolytes, is directly related to the bioimpedance v alues /Z/, we suppose that the changes in /Z/ would be a better reference value for the possible decrease in kidney functions than body ma ss (BM) that is currently used in most formulas for indirect assessment of GF. Therefore, we have attempted to construct a formula for re- nal function calculation, where serum creatinine concentration is corrected for the bioimpedance value. The formula has been de rived by multiple regression in a sample of 40 persons from their measured values of impedance and serum creatinine. The results of our study must be further standardized by a more precise method for kidney function evaluation, e.g. inulin, ioh exol or isotope method. If the correlation were good our method would make the kidney function assessment easier.
Development in nephrology
302 s. : il.
- MeSH
- ledviny metabolismus MeSH
- Publikační typ
- kongresy MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- nefrologie
- urologie
1st ed. vi, 115 s.
- MeSH
- ledviny fyziologie MeSH
- Publikační typ
- monografie MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- nefrologie
The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD) evaluation and management bring important updates, particularly for European laboratories. These guidelines emphasize the need for harmonization in CKD testing, promoting the use of regional equations. In Europe, the European Kidney Function Consortium (EKFC) equation is particularly suited for European populations, particularly compared to the CKD-EPI 2021 race-free equation. A significant focus is placed on the combined use of creatinine and cystatin C to estimate glomerular filtration rate (eGFRcr-cys), improving diagnostic accuracy. In situations where eGFR may be inaccurate or clinically insufficient, the guidelines encourage the use of measured GFR (mGFR) through exogenous markers like iohexol. These guidelines emphasize the need to standardize creatinine and cystatin C measurements, ensure traceability to international reference materials, and adopt harmonized reporting practices. The recommendations also highlight the importance of incorporating risk prediction models, such as the Kidney Failure Risk Equation (KFRE), into routine clinical practice to better tailor patient care. This article provides a European perspective on how these KDIGO updates should be implemented in clinical laboratories to enhance CKD diagnosis and management, ensuring consistency across the continent.
- MeSH
- chronická renální insuficience * diagnóza terapie MeSH
- cystatin C krev MeSH
- hodnoty glomerulární filtrace * MeSH
- klinické laboratoře MeSH
- kreatinin krev MeSH
- lidé MeSH
- směrnice pro lékařskou praxi jako téma * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
Contributions to nephrology ; Vol. 41
459 s. : il.
- MeSH
- kardiovaskulární nemoci etiologie MeSH
- kardiovaskulární systém patofyziologie MeSH
- nemoci ledvin komplikace MeSH
- Publikační typ
- kongresy MeSH
- sborníky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- nefrologie
- kardiologie
- MeSH
- hodnoty glomerulární filtrace MeSH
- inulin MeSH
- lidé MeSH
- nemoci ledvin diagnóza MeSH
- reprodukovatelnost výsledků MeSH
- rizikové faktory MeSH
- transplantace jater MeSH
- transplantace ledvin MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Assessment of kidney function in oncology patients is a fundamental factor in profiling the survival risk, determining the appropriate dose of chemotherapeutic drugs, and defining a patient eligibility for clinical trials with novel agents. Both overestimation and underestimation of kidney function may affect the treatment efficacy and outcomes. Overestimation may lead to overdosing or inappropriate agent selection and the corresponding toxicity, whereas underestimation may be responsible for underdosing or inappropriate agent exclusion and subsequent treatment failure. This is of utmost importance in patients with cancer. Evaluation of kidney function is not only limited to the estimation of glomerular filtration rate or creatinine clearance. An accurate assessment of kidney function is advisable to reduce variability in decision making and ultimately the therapeutic outcomes of toxicity and clinical benefit. Therefore, additional studies are needed to investigate the validity of currently used formulas estimating kidney function in this population as well as their applicability to traditional chemotherapy, novel targeted therapies, and immunotherapies. Because of rapid discovery and development of new cancer agents, a reliable and comprehensive manner to screen for potential nephrotoxicity is critically important. As kidney function not only is limited to glomerular filtration rate changes but also involves tubular and even vascular dysfunction, urinalysis and kidney imaging studies should also be considered before therapeutic decisions are taken. However, several questions remain regarding these new technologies such as kidney-on-a-chip systems for the assessment of kidney function and injury, particularly in oncology, and it has yet to be implemented in clinical practice.
- MeSH
- hodnoty glomerulární filtrace MeSH
- kreatinin MeSH
- ledviny * MeSH
- lidé MeSH
- nádory * farmakoterapie MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Kidney involvement is common in anti-neutrophil cytoplasm antibody-associated vasculitis (AAV) and the prognosis is determined by the severity of kidney damage. This study focused on long-term kidney outcomes, defining possible risk factors and comparing the performance of three different histological classifications to predict outcomes for patients with AAV. METHODS: The dataset included 848 patients with newly diagnosed AAV who participated in seven randomized controlled trials (RCTs) (1995-2012). Follow-up information was obtained from questionnaires sent to the principal investigators of the original RCTs. RESULTS: The cumulative incidence of end-stage kidney disease (ESKD) at 5 and 10 years was 17% and 22%, respectively. Patients who developed ESKD had reduced patient survival compared with those with preserved kidney function (hazard ratio 2.8, P < .001). Comparing patients with AAV and kidney involvement with a matched general population, patients with AAV had poor survival outcomes, even in early stages of chronic kidney disease. The main cause of death was infection followed by cardiovascular disease in patients developing ESKD and malignancy in those who did not. Some 34% of patients with initial need for dialysis recovered kidney function after treatment. Thirty-five out of 175 in need of kidney replacement therapy (KRT) during follow-up received a kidney transplant with good outcome; there was 86% patient survival at 10 years.In the subcohort of 214 patients with available kidney biopsies, three scoring systems were tested: the Berden classification, the Renal Risk Score and the Mayo Clinic Score. The scores highlighted the importance of normal glomeruli and severe glomerulosclerosis on kidney survival (P < .001 and P = .001, respectively). The Renal Risk Score demonstrated a moderate prediction of kidney survival (area under the curve 0.79; standard error 0.03, 95% confidence interval 0.71-0.83). CONCLUSIONS: Early diagnosis of AAV is extremely important. Even milder forms of kidney involvement have an impact on the prognosis. Patients in need of KRT had the lowest survival rates, but kidney transplantation has shown favorable outcomes for eligible AAV patients. The three histologic scoring systems were all identified as independent prognostic factors for kidney outcome.
- MeSH
- ANCA-asociované vaskulitidy * komplikace mortalita terapie MeSH
- chronické selhání ledvin * mortalita terapie etiologie MeSH
- dospělí MeSH
- hodnoty glomerulární filtrace MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- následné studie MeSH
- prognóza MeSH
- rizikové faktory MeSH
- senioři MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
