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PubMed1995

[Assessment of formulas of predicted creatinine clearance from serum creatinine].

Much effects have offered to make formulas of predicted creatinine clearance (Ccr) from serum creatinine, sex, age, body weight and height. In this study, we examined 13 kinds of predicted formulas of Ccr that have been previously published. And instead of an actual body weight, we have attempted to use 4 kinds of ideal body weight (two of them reported in Japan, the others in United States) or a lean body weight. A total of 13 subjects were studied (2 healthy males and 11 males with chronic renal disease) to determine Ccr with urine collection for one hour and simultaneous measurement of inulin clearance (Cin). A highly statistical correlation between determined Ccr and predicted Ccr was observed. From predicted formula with one hour urine collection, standard error of estimation (SEE) was smallest. According to determined Cin, the subjects examined was divided into two groups (group A; Cin > or = 50 ml/min, group B; Cin < 50 ml/min). In most formulas, B group had higher correlation than A group, and each regression line got nearer to the identical line (Y = X) and SEE became smaller. The subjects examined were divided into two groups by body mass index (BMI). One is an obese and the other is a nonobese. In an obese group, SEE became smaller when an ideal body weight or a lean body weight were used in formulas instead of actual body weight. We could conclude that the clearance time and ideal or lean body weight of the patients are most important factors to assess predicted Ccr.

Adult↗
PubMed1994

Estimating creatinine clearance in elderly patients with low serum creatinine concentrations.

The accuracy of creatinine clearance (CLcr) estimates generated for elderly patients with a low serum creatinine (SCr) concentration when the SCr concentration was rounded to 1.0 mg/dL was evaluated, and daily aminoglycoside dosages calculated with CLcr estimates based on the actual and the rounded SCr concentrations were compared with the actual dosage required as determined by aminoglycoside concentration measurements. Twenty-four-hour urine collections were obtained from elderly hospitalized patients with stable renal function, and CLcr was measured. SCr concentrations were measured at baseline, during urine collection, and after urine collection. CLcr was calculated twice with each of seven methods, once by using the actual SCr concentration and once by rounding the SCr concentration to 1.0 mg/dL. Rounding the SCr concentration to 1.0 mg/dL resulted in significant underestimation of CLcr by all seven methods. The Cockcroft-Gault equation used with ideal body weight and the rounded SCr concentration resulted in the largest bias. For six of the seven methods, bias was greater and precision less when SCr concentrations of < 0.7 mg/dL were rounded than when SCr concentrations of > or = 0.7 mg/dL were rounded. The Bjornsson method used with the actual SCr concentration appeared to offer the best combination of low bias and high precision. The required aminoglycoside dosage was significantly underestimated when the rounded SCr concentration was used. In elderly patients with low SCr concentrations, rounding the SCr concentration to 1.0 mg/dL led to underestimates of both CLcr and the correct aminoglycoside dosage.

Aged↗
PubMed1988

Superiority of disease-specific over conventional formula in predicting creatinine clearance from serum creatinine in patients with liver cirrhosis.

To determine if liver cirrhosis may influence the accuracy of formulas estimating creatinine clearance (Clcr) from serum creatinine, we compared the measured and estimated Clcr in 95 male (group A) and 47 female cirrhotic patients (group B). The Clcr values of group A and B patients were estimated with the equations obtained from 93 male (group C) and 86 female patients (group D) who were free of liver disease: the mean estimation errors (+/- SD) for the group C and D patients with the equations obtained from their own population data were 5 +/- 24% and 4 +/- 22%, respectively. However, these equations significantly (p less than 0.01) overestimated the Clcr of cirrhotic patients: the mean estimation errors for the group A and B patients were 35 +/- 43% and 14 +/- 27%, respectively. In contrast, the mean estimation errors for the group A and B patients using cirrhotic patient-specific equations obtained from their own population data were 5 +/- 33% and 3 +/- 25%, respectively. The accuracy of these disease-specific formulas was also confirmed in a prospective manner in 43 male (group E) and 21 female cirrhotic patients (group F): the mean estimation errors for the group E and F patients were 2 +/- 32% and -7 +/- 29%, respectively. We conclude that the Clcr values of cirrhotic patients, particularly male patients, may not be accurately estimated with equations of formulas deriving from liver disease-free patients, but should be estimated using their own population data.

Creatine↗
PubMed1993

Relationship between dietary protein intake and serum urea, uric acid and creatinine, and 24-hour urinary creatinine excretion: the BIRNH Study.

Relationships between dietary protein intake of a large free-living group and serum creatinine (Cr), urea and uric acid levels have been studied, based on data obtained from the BIRNH (Belgian Interuniversity Research on Nutrition and Health) study. Highly significant correlations were found in both sexes for total protein, as well as for animal and vegetable protein intake. In a subgroup, the relationship between dietary protein intake and 24-hour urinary Cr excretion has also been studied. The range of +/- 2 SD of the mean for total protein and animal and vegetable protein daily intakes resulted in a calculated range of 24-hour Cr excretion of 430, 317 and 209 mg/24 hours in men and of 192, 169 and 125 mg/24 hours in women, respectively. The 24-hour urinary Cr excretion was significantly influenced by both dietary protein and polyunsaturated fat intake.

Adult↗
PubMed1997

New method to calculate creatinine generation rate using pre- and postdialysis creatinine concentrations.

The creatinine (Cr) generation rate reflects the muscle mass, a possible indicator of protein nutritional status. Thus, in this study, we developed equations for calculating the Cr generation rate. Depner and Daugirdas recently developed a method for determining the protein catabolic rate (PCR) from the pre- and postdialysis blood urea nitrogen concentrations. We modified their method to develop equations for calculating the total Cr generation rate from the measured predialysis Cr concentration and estimated postrebound concentration. The total Cr generation rate is defined as the sum of the intrinsic Cr generation rate and the extrinsic Cr generation rate (i.e., the generation rate of Cr derived from food). In the present study, the postrebound Cr concentration was estimated on the basis of postdialysis Cr concentration and the K/V for Cr. The intrinsic Cr generation rate was obtained by subtracting the extrinsic Cr generation rate, which was estimated on the basis of the PCR, from the total Cr generation rate calculated. The intrinsic Cr generation rate determined with this method was virtually the same as that obtained using the postrebound Cr concentration, the concentration immediately before the next hemodialysis (HD) session, and the PCR. The intrinsic Cr generation rate determined with the present method did not vary with changes in the HD prescription (i.e., with an increase in blood flow rate, a prolongation of the HD duration time, or a change in dialyzer membrane area). The present study also indicated that the intrinsic Cr generation rate decreased with age in both males and females.

Adult↗
PubMed1998

Poor correlation between published methods to predict creatinine clearance and measured creatinine clearance in asymptomatic HIV infected individuals.

The purpose of this study was to evaluate the predictive ability of six published creatinine clearance (CCr) equations in healthy human immunodeficiency virus (HIV) infected individuals. A 24-h urine collection to determine CCr was done on an out-patient basis in 18 subjects. Predicted CCr was compared with the measured values, and the predictive performance was assessed with percentage mean error (bias) and percentage root mean error (precision). Mean +/- standard deviation measured CCr was 107 +/- 35 mL/min/1.73 M2. CCr determined using each of the published equations correlated poorly with measured values. CCr determined using Hull methods was significantly different from the measured values. Though Cockcroft and Gault and Jelliffe methods had the lowest mean bias and greater precision, a significant range of difference from measured CCr was observed (-12 to +28%). All methods over estimated the measured CCr in HIV-infected individuals. Until other approaches are developed, a 24 h urine collection may be the best approach for assessing renal function in HIV-infected individuals, especially in those receiving medications with narrow therapeutic indices that are cleared by the kidney.

Adult↗
PubMed1988

[The equilibrium of nitrogen, potassium and phosphate and renal excretion of creatinine and creatinine over the course of 3 weeks following severe trauma].

In 19 patients after accidental trauma and with intact renal function during an observation time of 21 days we found a cumulated negative balance of nitrogen (N), phosphate (P) and potassium (K) amounting to a mean of 214g, 357 and 447 mmol, respectively. Median daily potassium balance was positive on day 2 to 5 and this was interpreted as an increased extrarenal potassium deposition due to increased levels of circulating catecholamines. Median renal creatinine excretion was about 120% of predicted normal till day 10 and continuously decreased thereafter to values lower than predicted normal. Three patients did not show creatinuria (greater than 200 mg/day) during the whole observation time. In 15 patients after a "free interval" with a mean duration of 7 days creatinuria frequently developed rather quickly and maximal excretion of creatine was as high as 4 g/day. In 7 patients creatinuria persisted to the end of the 21 days observation time. During the phase of creatinuria the median cumulated excretion of creatine amounted to 14.4 g. The "free interval" of creatinuria after severe trauma is remarkable. Most of the N, K and P, which is lost from the body during this time obviously stems from tissues other than sceletal muscle. During the phase of creatinuria, however, the negative balance of N, K and P seems to be mainly due to muscle wasting. Hypophosphatemia was prominent during the first 5 days after trauma and obviously was caused by a decrease in renal phosphate threshold (TmPO4/GFR). The underlying mechanism of this primary change in renal function after severe trauma could not yet be identified.

Adolescent↗
PubMed1987

[The determination of creatinine--the Jaffe reaction 100 years later. On the occasion of the 75th anniversary of the death of Max Jaffe, discoverer of the picric acid reaction of creatinine].

In this article is called to mind that over 100 years ago Max Jaffe (1841-1911) for the first time described the picric acid reaction of creatinine, on which are based the at present performed methods of determination of this metabolic end product on the clinical diagnostics. A short biography of the researcher is given and his particular merits for biochemistry are appreciated in the light of the scientific subjects he dealt with.

Creatinine↗
PubMed1993

[Predictability of creatinine clearance from serum creatinine in chronic glomerulonephritis].

We evaluated the formulas of urine-free prediction of creatinine clearance (CCr) for clinical use in the patients with chronic glomerulonephritis (CGN). Subjects were 246 patients with CGN diagnosed by renal biopsy with range from normal renal function to end stage renal failure. CCr were measured exactly with urine collections more than 2 times and compared with the values calculated using four urine-free mathematical formulas of Cockcroft et al, Mawer et al, Konishi et al, and Tozune et al. Strong, statistically significant correlations were observed between CCr estimated with each prediction method and measured CCr (r > or = 0.946). However, the latter two formulas tended to overestimate the values. Predicted errors more than 20% of the formula of Cockcroft et al, were the least. And their formula was the easiest for clinical use because of the simplicity for learning by heart. We conclude that these four formulas can be used with reasonable accuracy in the patients with CGN from normal renal function to end stage renal failure, and the formula of Cockcroft et al, is the most recommendable for clinical use.

Adolescent↗
PubMed1994

NAG, GGT, creatinine, urea and creatinine clearance before and after ESWL.

N-acetyl-beta glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in the urine and serum before, 24 hours and one week after extracorporeal shock wave lithotripsy in 25 patients. Although ESWL is the preferred method in the treatment of kidney stones, its effect on renal parenchymal cells has not been sufficiently elucidated. Since radiographic methods remain inadequate in the estimation and management of parenchymal damage, it is useful to establish the specific renal cell proteins in urine and serum, reflecting renal tubular cell destruction.

Acetylglucosaminidase↗