BACKGROUND: The aim of the study is to compare measured glomerular filtration rate by technetium radiolabled diethylene tiamine pentaacetic acid (mGFR DTPA) to estimated GFR (eGFR). Glomerular filtration rate (GFR) is estimated from serum creatinine (eGFRcreatinine), serum cystatin C (eGFRcystatin C) and by combined equation (eGFRcreatinine+cystatin C). This study focuses on oncology patients considered for treatment with cisdiamminedichloroplatinum (cisplatin). We evaluated the impact of different GFR methods on the reduction of cisplatin dose. PATIENTS AND METHODS: The study population consisted of 112 consecutive oncology patients from oncology center treated in the town of Zlin in the Czech Republic, who were considered for cisplatin treatment. mGFR DTPA was performed by dynamic renal 99mTc scintigraphy method using diethyltriaminepentaacetic acid. Creatinine and cystatin C were determined by newly standardized tests. Estimation of GFR was calculated using The Chronic Kidney Disease Epidemiology (CKD EPI) equations which were established in 2009 and 2012. RESULTS: The median (interquartile range) of mGFR DTPA was 1.335 ml/s/1.73 m2 (1.070-1.725). The median of eGFRcystatin C 1.195 ml/s/1.73 m2 (0.885-1.625) was lower than mGFR DTPA (p<0.05). The median of eGFRcreatinine 1.460 ml/s/1.73 m2 (1.210-1.660) was higher than mGFR DTPA (p<0.05). Correlation analysis and Bland Altman plots show high individual differences between mGFR DTPA and all eGFRs. CONCLUSIONS: Oncology patients are a very special group of patients who dif-fer from general population. There are significant individual differences between mGFR DTPA and all eGFRs, impacting detection rate of CKD and potential drug dosage adjustment.

• MeSH
• antitumorózní látky terapeutické užití   MeSH
• cisplatina terapeutické užití   MeSH
• cystatin C krev   MeSH
• hodnoty glomerulární filtrace * MeSH
• kreatinin krev   MeSH
• lidé MeSH
• nádory farmakoterapie   patofyziologie   MeSH
• technecium 99mTc pentetát MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antitumorózní látky MeSH
• cisplatina MeSH
• cystatin C MeSH
• kreatinin MeSH
• technecium 99mTc pentetát MeSH

BACKGROUND: The aim of the study was to analyze the degree of obesity and its associations with age, gender, inflammation, an estimated glomerular filtration rate (eGFR), and liver function in type 2 diabetes mellitus (T2DM) patients. METHODS: A total of 874 consecutive adult Caucasian T2DM patients from outpatient diabetic clinic were included in the study. The relative fat mass (RFM) and body mass index (BMI) were used as obesity markers. Serum creatinine and cystatin C were used for the GFR estimation. Serum high-sensitive C-reactive protein (hsCRP) was used as the indicator of inflammation. RESULTS: The median, interquartile range (IQR) of RFM in females was higher than that in males (44.8 (42.3-47.2) % vs 31.3 (28.8-34.1) %, respectively; P < .0001). The median (IQR) of BMI in females was no higher than that in males (30 (27-34) kg/m2 vs 30 (27-34), respectively; P = .5152). The obesity prevalence was 99% in males and 98% in females according to RFM. BMI recognized obesity in 51% males and 53% females. RFM was positively associated with hsCRP in both males (rs = .296, P < .0001) and females (rs = .445, P < .0001). ALT was positively correlated with eGFRcys in both males (rs = .379, P < .0001) and females (rs = .308, P < .0001). CONCLUSION: The RFM equation leads to higher obesity prevalence compared to BMI. Women have higher RFM compared to men. The kidney function was positively correlated with ALT serum concentrations.

• Klíčová slova
• abdominal fat, adipose tissue, alanine transaminase, body mass index, cystatin C, diabetes mellitus, glomerular filtration rate, inflammation, kidney diseases, obesity,
• MeSH
• C-reaktivní protein analýza   MeSH
• chronická renální insuficience etiologie   patofyziologie   MeSH
• diabetes mellitus 2. typu komplikace   patofyziologie   MeSH
• hodnoty glomerulární filtrace * MeSH
• index tělesné hmotnosti MeSH
• jaterní testy MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tuková tkáň * patofyziologie   MeSH
• zánět etiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• C-reaktivní protein MeSH

PURPOSE OF REVIEW: To compare laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) performed in two European tertiary centers using the classic optimal surgical definition - "MIC" - and a new optimal surgical definition: the "Novel TRIFECTA" (NT) concept. We sought to strengthen the PN evidence and to test the NT's performance. RECENT FINDINGS: The study population comprehended 505 cases of localized kidney cancer from two tertiary centers between 2012 and 2019. The NT achievement was higher in the RAPN group when compared to LPN (70.5 vs. 87.4%; p = 0.004), while no differences were found when considering the MIC criteria. Also, a similar high-grade complications rate (Clavien-Dindo > III) and operative time (105 min vs. 100 min; p = NS) were found. In the multivariable regression, the RAPN approach was a predictor of NT achievement (OR 2.45; p = 0.008). NT achievement was higher in the RAPN group, while similar results were found when evaluating the MIC criteria. The NT definition could be more sensitive to the individual-specific responses related to the PN.

• Klíčová slova
• Acute kidney injury, Carcinoma renal cell, Minimally invasive surgical procedures, Nephrectomy, Robotic surgery procedures,
• MeSH
• hodnoty glomerulární filtrace * MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony * MeSH
• nádory ledvin patofyziologie   chirurgie   MeSH
• nefrektomie * MeSH
• pooperační péče * MeSH
• senioři MeSH
• tendenční skóre MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Impaired kidney concentration capacity is present in half of the patients with autosomal dominant polycystic kidney disease (ADPKD). The kidney concentrating capacity was further impaired within the animal model of autosomal recessive polycystic kidney disease (ARPKD). To date, only one small study has investigated it in children having ARPKD. Therefore, we aimed to study the kidney concentrating ability in a larger cohort of children with ARPKD. METHODS: Eighteen children (median age 8.5 years, range 1.3-16.8) were retrospectively investigated. A standardized kidney concentrating capacity test was performed after the application of a nasal drop of desmopressin (urine osmolality > 900 mOsmol/kg). The glomerular filtration rate was estimated using the Schwartz formula (eGFR) and blood pressure (BP) was measured as office BP. RESULTS: Kidney concentrating capacity was decreased (urine osmolality < 900 mOsmol/kg) in 100% of children with ARPKD. The median urine osmolality after desmopressin application was 389 (range 235-601) mOsmol/kg. Sixteen patients (89%) were defined as hypertensive based on their actual BP level or their use of antihypertensive drugs. The maximum amounts of urinary concentration correlated significantly with eGFR (r = 0.72, p < 0.0001) and hypertensive scores (r = 0.50, p < 0.05), but not with kidney size. Twelve patients (67%) were defined as having CKD stages 2-4. The median concentrating capacity was significantly lower in children within this group, when compared to children with CKD stage 1 possessing a normal eGFR (544 mOsmol/kg, range 413-600 mOsmol/kg vs. 327 mOsmol/kg, range 235-417 mOsmol/l, p < 0.001). CONCLUSIONS: Impaired kidney concentrating capacity is present in most children with ARPKD and is associated with decreased eGFR and hypertension. A higher resolution version of the Graphical abstract is available as Supplementary information.

• Klíčová slova
• Glomerular filtration rate, Hypertension, Kidney length, Pediatric population,
• MeSH
• chronická renální insuficience * komplikace   MeSH
• desmopresin MeSH
• dítě MeSH
• hodnoty glomerulární filtrace MeSH
• hypertenze * MeSH
• ledviny MeSH
• lidé MeSH
• polycystické ledviny autozomálně dominantní * MeSH
• polycystické ledviny autozomálně recesivní * komplikace   MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• desmopresin MeSH

INTRODUCTION: Estimation of changes of glomerular filtration rate based on accurate measurement (GFR) and that based on predicting formulas (eGFR) could differ significantly. In this study we have tried to analyse the relationship between (eGFR)t2/(eGFR)t1 and (GFR)t2/(GFR)t1 (where t1 and t2 denote the time at the beginning and the end of the follow-up interval). METHODS: Renal clearance of inulin (Cin) was repeatedly examined in 32 patients suffering from chronic renal impairment (S(Cr) = 231 +/- 70 micromol/l). Estimated GFR (eGFR) was calculated on the basis of Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (CG) equations. RESULTS: A significant relationship between (MDRD)t2/(MDRD)t1 and (Cin)t2/(Cin)t1 (r = 0.544, p = 0.0028, R2 = 0.295) as well as between (CG)t2/(CG)t1 and (Cin)t2/(CG)t1 (r = 0.556, p = 0.0026, R2 = 0.309) was found. Average difference between (MDRD)t2/(MDRD)t1-(Cin)t2 /(Cin)t1 was 0.017 +/- 0.17 and that of (CG)t2 /(CG)t1-(Cin)t2/ (Cin)t1 was 0.024 +/- 0,18. Within +/- 0.20 of the difference (eGFR)t2/(eGFR)t1-(Cin)t2 /(Cin)t1 59 % values were found and within +/- 0.30 of this difference 75% values were recorded. Highly significant relationship was found between (MDRD)t2/(MDRD)t1 and (CG)t2/(CG)t1 (r = 0.991; p = 0.0001; R2 = 0.983). CONCLUSION: Considering these preliminary findings, predicting formulas are not sensitive sufficiently to by able to detect GFR changes lower than 30% of initial value.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace * MeSH
• inulin MeSH
• kreatinin krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin patofyziologie   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
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• inulin MeSH
• kreatinin MeSH

Our study aimed to establish the best prediction equation for different age ranges in estimating Glomerular Filtration Rate (GFR) in clinical practice in Slovakia. The GFR by 24-hour creatinine clearance (Ccr) and the estimated GFR (eGFR) using the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were obtained in adults aged 30-80 (n = 433, 10-years intervals). The correlation between these prediction equations and Ccr was evaluated. Errors in prediction equations were detected by moving average and by comparisons of the formulas for GFR < 1.5 ml/s and > 1.5 ml/s. The best correlations were established between Ccr and MDRD4 for women (r = 0.7790) and men (r = 0.8009), and between Ccr and CKD-EPI for women (r = 0.7780) and men (r = 0.8002) in the 60-69 age range. High correlation was also established between Ccr and CG (r = 0.8655) and MDRD4 (r = 0.8713) for men in the 40-49 age range. With the exception of the 30-40 age range, a low prediction error was observed for each age range in both genders when GFR was < 1.5 ml/s. We recommend utilization of the MDRD4 and CG equations for men (40-49 years) and MDRD4 and CKD-EPI for women and men (60-69 years), as preferred substitutes for Ccr.

• MeSH
• chronická renální insuficience diagnóza   patofyziologie   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• kreatinin krev   moč   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• senioři MeSH
• věkové rozložení MeSH
• vyšetření funkce ledvin metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH
• Názvy látek
• kreatinin MeSH

This prospective study evaluated the relationship between echocardiography parameters of left ventricular (LV) diastolic function and mild-to-moderate renal function impairment in 82 patients with type 2 diabetes mellitus. The mean age of the patients was 61.1 years. A significant correlation was found between estimated glomerular filtration rate (eGFR) and the ratio of peak velocity of early transmitral flow (E) to peak velocity of early diastolic mitral annular motion (E'). Cluster analysis revealed two subgroups of patients with different E' values but comparable eGFRs. The correlation between eGFR and E/E' was significant in 38 patients with E' ≤ 7.1 cm/s, but not significant in 44 patients with E' > 7.1 cm/s. The results suggest that the deterioration of LV relaxation (E') represents the underlying condition for the association between mild-to-moderate renal function impairment and the non-invasive parameter of LV end-diastolic pressure (E/E'), in patients with type 2 diabetes without any previous cardiovascular event and with well-controlled blood pressure.

• MeSH
• demografie MeSH
• diabetes mellitus 2. typu diagnostické zobrazování   patofyziologie   MeSH
• diastola fyziologie   MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční fyziologie   MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multivariační analýza MeSH
• senioři MeSH
• shluková analýza MeSH
• ultrasonografie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Amikacin monotherapy is recommended for urinary tract infection (UTI) treatment with multi-resistant pathogens. Even though amikacin efficacy in the treatment of UTIs is dependent on its urinary concentration, there are no robust data proving that sufficiently high urinary concentration is reached in patients with reduced glomerular filtration rate (GFR). METHODS: A prospective study to monitor amikacin penetration into urine of 70 patients [40 males, median (interquartile range) age 70 (65-79) years] with different levels of glomerular filtration decline, including patients treated by dialysis, was conducted. The bactericidal efficacy of amikacin in urine samples has been evaluated. RESULTS: Patients with estimated GFR (eGFR) <30 mL/min had significantly lower median amikacin urinary concentration than patients with eGFR >30 mL/min (89.75 vs 186.0 mg/L, P < .0001; 200.5 vs 830.0 mg/L, P < .0001; and 126.0 vs 408.0 mg/L, P < .0001 for minimal, maximal and minimal together with maximal concentrations, respectively). The amount of amikacin eliminated in the first 10-13 h after dose administration was dependent on eGFR (r2 = 0.6144, P < .0001). The urinary concentration of amikacin in patients treated by dialysis was indirectly proportional to pH of urine. The plasma concentrations of amikacin did not correlate with urinary levels in patients in either of the GFR categories. Microbiological evaluation showed that the critical urinary concentration for efficacy of amikacin during UTI monotherapy in patients treated by dialysis is 100 mg/L. We found that 4 out of 11 patients treated by dialysis did not reach this level during the treatment. CONCLUSION: Systemic administration of amikacin monotherapy in patients treated by dialysis is questionable as the concentrations of amikacin in their urine are often below the threshold of effectivity. Amikacin plasma concentrations are not a major determinant of amikacin concentration in urine, therefore pulse dosing is neither necessary nor safe in patients treated by dialysis, and may cause undesirable toxicity.

• Klíčová slova
• UTI, aminoglycosides, dialysis, kidney impairment, pharmacokinetics,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: It is not known whether withdrawal of angiotensin-converting enzyme inhibitors (ACEIs) in children with advanced chronic kidney disease (CKD) is beneficial similar to adults. We report a case series of children with advanced CKD whose ACEIs were stopped. METHODS: In the last 5 years, we stopped ACEIs in seven consecutive children on ACEI therapy with rapidly declining CKD stage 4-5. The median age was 12.5 years (range 6.8-17.6); the median estimated glomerular filtration rate (eGFR) at stopping ACEIs was 12.5 ml/min/1.73 m2 (range 8.8-19.9). RESULTS: Six to twelve months after stopping ACEIs, the eGFR increased in five children (71%). The median absolute increase of eGFR was 5.0 ml/min/1.73 m2 (range -2.3 to +20.0) and relative increase of eGFR was 30% (range -34 to +99). The median follow-up after stopping ACEIs was 2.7 (range 0.5-5.0) years, either until the start of dialysis (n = 5) or until the last follow-up without dialysis (n = 2). CONCLUSIONS: This case series showed that withdrawal of ACEIs in children with CKD stage 4-5 and rapidly declining kidney function may lead to an increase in eGFR.

• Klíčová slova
• blood pressure (BP), case report, chronic kidney disease, estimated glomerular filtration rate (eGFR), proteinuria,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Patients taking digoxin are older with high probability of having low muscle mass, and current clinical practice in digoxin dosing relies only on estimated glomerular filtration rate from serum creatinine (eGFRcrea). The aim of the study is to compare eGFRcrea and estimated glomerular filtration rate from serum cystatin C (eGFRcys) in older adult patients with atrial fibrillation (AF) overdosed with digoxin. METHODS: A total of 80 consecutive patients overdosed with digoxin and 33 controls with AF from Department of Internal Medicine were included in the prospective observational study. The median of age of participants was 81 years in both the overdosed and the control group. The eGFRs were calculated using The Chronic Kidney Disease Epidemiology (CKD- EPI) equations using standardized methods for serum creatinine and cystatin C measurement. RESULTS: The median (IQR) of eGFRcrea was higher than that of eGFRcys (45 mL/min/1.73 m2 (35-59) vs 30 (21-38), respectively; P < .0001) in overdosed patients. The median (IQR) of eGFRcrea was higher than that of eGFRcys (61 mL/min/1.73 m2 (49-72) vs 40 (30-56), respectively; P < .0001) in control group of patients. Serum predose digoxin concentration in overdosed patients was inversely associated with eGFRcys (ρ = -0.26, P < .05). CONCLUSION: Physicians should consider GFR when changing digoxin dosing. eGFRcys was lower in both the overdosed and the control group. eGFRcys would lead to lower digoxin doses and thus prevent overdose.

• Klíčová slova
• atrial fibrillation, creatinine, cystatin C, digoxin, estimated glomerular filtration rate, glomerular filtration,
• MeSH
• cystatin C krev   MeSH
• digoxin farmakologie   terapeutické užití   MeSH
• fibrilace síní krev   farmakoterapie   patofyziologie   MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• kreatinin krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cystatin C MeSH
• digoxin MeSH
• kreatinin MeSH