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PubMed2006

Kidney function and cardiovascular disease in the hypertensive population: the ERIC-HTA study.

BACKGROUND AND OBJECTIVES: Epidemiological data on the incidence and prevalence of cardiovascular disease in chronic renal failure are scant The objective of the present study is to assess the relationship between renal function, measured by the estimated glomerular filtration rate, and the presence of early or established cardiovascular disease, in a population of hypertensives from primary care. PATIENTS AND METHODS: Cross-sectional, multicentre study carried out in primary care centres all over Spain. Hypertensive subjects, older than 55 years, were included. In all of them a structured interview including cardiovascular risk factors or disease was performed. Blood pressure was measured following a standard procedure, and serum biochemistry and an electrocardiogram were obtained. Renal function was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease Study Group) equation. For each glomerular filtration rate stratum the odds ratio and 95% confidence interval (CI) of left ventricular hypertrophy or cardiovascular disease were calculated, adjusted by confounding variables. RESULTS: A total of 13 687 patients (mean age 68.1 years, women 55.4%, diabetics 30.6%, body mass index 28.6 kg/m2) were included. Of these, 26.4% had established cardiovascular diseases and 20.3% electrocardiographic left ventricular hypertrophy. The average serum creatinine was 1.01 mg/dl, creatinine clearance 70.0 ml/min, and glomerular filtration rate 74.0 ml/min per 1.73 m2. Thirty-three patients (0.24%) had glomerular filtration rate < 5 ml/min per 1.73 m2; 89 (0.65%) from 15 to 29; 3745 (27.36%) from 30 to 59; 7798 (56.97%) from 60 to 89; and 2019 (14.75%) higher than 89 ml/min per 1.73 m2. In a multiple regression analysis, after adjusting by age, sex, body mass index, diabetes, systolic and diastolic blood pressure, and smoking, a lower glomerular filtration rate was associated with a higher prevalence of left ventricular hypertrophy. Likewise, a reduction in the glomerular filtration rate was also associated with a higher prevalence of cardiovascular disease. CONCLUSIONS: In hypertensive patients from primary care, the prevalence of cardiovascular disease is inversely proportional to the level of renal function. Estimated glomerular filtration is easy to determine and complements evaluation of the hypertensive patient.

Aged↗
PubMedDate not supplied

[Effects of aging on kidney function and implications for medical practice].

PHYSIOLOGICAL AGING: Anatomical and physiological renal changes occur during normal aging in humans. These changes are different from the renal effects of many diseases frequently linked to aging and which require specific diagnosis, prevention and therapy. Renal aging varies from one patient to another or from one population to another. During common aging, anatomical changes are mild and physiological changes mainly affect glomerular filtration rate and water and salt metabolism regulation. IN THE ELDERLY: Glomerular filtration rate decreases slowly in healthy elderly people to reach 80 ml/mn at 80 years without any metabolic consequence. However, in old hospitalized patients, acute renal failure is frequent and occurs mainly during inflammatory or infectious disorders, dehydration or drug combinations enhancing regulation of glomerular filtration. Tubular function changes expose the elderly to increasing risk of dehydration which could be prevented in highly predictable situations such as gastrointestinal symptoms, poorly salted diets or anorexia. Estimation of the creatinine clearance is necessary whenever an acute medical events, mostly infectious diseases, occur in elderly people to adapt drugs doses to renal catabolism.

Acute Kidney Injury↗
PubMed1995

The acute effect of ioversol on kidney function: role of endothelin.

The effect of ioversol, a non-ionic monomer with high hydrophilicity, on renal function was studied using the isolated perfused rat kidney (IPRK). The involvement of endothelin in the renal effect of ioversol was established pharmacologically using the selective endothelin ETA receptor antagonist BQ123. Ioversol 20 mgI/ml produced a sustained fall in both renal perfusate flow (RPF) and the glomerular filtration rate (GFR) together with a fall in sodium reabsorption (FRNa) and increase in urine flow (n = 6). In the presence of BQ123 (10 microM), the effect of ioversol 20 mgI/ml on GFR was completely abolished and the fall in RPF and FRNa markedly reduced (n = 6). These results suggest that effect of ioversol on renal haemodynamics in the IPRK is mediated by endothelin. Ioversol produced a significantly smaller decrease in GFR than iopromide, a contrast media with similar osmolality but lower hydrophilicity, when compared to a previous study using an identical experimental technique. Increased hydrophilicity may therefore present an advantage for ioversol, reducing its effects on renal function.

Animals↗
PubMed1992

Kidney functioning during lithium treatment: a prospective study of patients treated with lithium for up to ten years.

A cohort of 53 patients with affective disorders who originally carried through renal functional tests before start of prophylactic lithium treatment were followed up prospectively after an average period of 8.5 years (range 7-10 years). Ten patients who had continued lithium treatment were re-examined. In this subgroup, the glomerular function was unaffected by the treatment, whereas the average urine volume increased during lithium treatment (NS). Polyuria and low renal concentrating abilities were also found before start of treatment and these findings underline the importance of access to renal baseline information prior to lithium treatment.

Adult↗
PubMed1991

[ACE inhibition in heart failure and compromised kidney function].

If ACE-inhibitors are considered for therapy in patients with heart failure, the actual renal function has to be taken into account. In patients with reduced intravascular volume, e.g. during therapy with diuretics, the renin-angiotensin system is activated. In this situation, the renin-angiotensin-system contributes to the maintenance of arterial blood pressure and glomerular filtration rate by angiotensin II mediated vasoconstriction in vas efferens and systemic circulation. A sudden complete inhibition of the renin-angiotensin system therefore may cause a pronounced decrease in blood pressure and a reduction in glomerular filtration rate (impaired renal excretory function). In patients with heart failure concomitant chronic renal failure, the use of ACE-inhibitors is without major risk; however, the clinical efficacy may be limited. This does not apply to patients with diabetes, where the risk for impairment of renal function is increased. The potential advantage of short acting ACE-inhibitors such as captopril may clinically be relevant only in patients with very advanced severe heart failure and low arterial pressure. In any case, it is recommended to start ACE-inhibitors with a low dose and withdraw diuretics one or two days before in order to restore the intravascular volume.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

[Dynamics of kidney function by renography findings in the connection to the results of radiotherapy of urinary bladder cancer].

The paper is devoted to analysis of the potentialities of radionuclide renography as a method for assessment of the effectiveness of radiotherapy of bladder cancer. The results obtained suggested close correlation between change of renal function and the results of irradiation. Normal renal function was observed in 3 patients, improvement--in 16 patients, and deterioration--in 8 patients whereas a complete effect of radiotherapy brought about the following figures: 5, 11 and 3, respectively. A conclusion was made of a high significance of renography parameters in objective assessment of the results of radiotherapy of bladder cancer in conjunction with other therapeutic modalities.

Aged↗
PubMed1985

[Monitoring kidney function in abdominal infection].

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss. The clearance values are corrected to 1.73 m2 body surface area. Free water clearance proved to be a particularly valuable guide for fluid therapy as well as for early diagnosis of ARF. In all septic patients renal function is impaired to some degree, since despite increased cardiac output creatinine clearance is only normal or even decreased. More than 50% of our patients with abdominal sepsis develop ARF, resulting in a dramatic increase in mortality. Goal of renal monitoring in sepsis is to detect ARF as early as possible and to differentiate between extrarenal and septic origin to enable immediate surgical treatment.

Acute Kidney Injury↗
PubMed1996

[Kidney function tests in horses--methods and reference values in healthy animals].

Investigations of renal function have been done on the basis of renal clearance (Clr) and excretion (E) of endogenous creatinine in healthy horses of different body weight (23 female, 7 male). Creatinine was measured by enzymatic PAP-method. Creatinine-E of female horses was poor positively correlated with body weight. The creatinine-Clr was highly correlated with the inulin-Clr (r = 0,896, p < 0,001). The excretion of creatinine was 35% higher than the filtration of creatinine, determined by inulin-Clr. That demonstrate a tubular net secretion of 26% of the total creatinine excretion. However the creatinine-Clr may be considered representative enough for the glomerular filtration rate (GFR). Water, sodium, glucose and L-lactate were absorbed in the renal tubules nearly completely, with a fractional excretion (FE) lower 2%. So they are suitable as endogenous markers for insufficient tubular absorption. Other electrolytes were absorbed incompletely depending on the supply of these substances (calcium-FE and magnesium-FE: 1-50%, potassium-FE: 10-120%, phosphate-FE: 0-5%). An extremely variable part of the filtered urea was reabsorbed in the tubuli (urea-FE 8-85%). For that reason urea is not appropriate for the diagnostic of disturbances of renal functions. A method for clinical determination of renal function by measurement of concentrations of metabolites and electrolytes in blood plasma and spontaneous urine is described and evaluated. The method is based on the supposed constant excretion of the creatinine (0,17 mumol/min/kg) and allows especially the examination of male and sick animals without quantitative sampling of urine. Reference-values for the renal excretion of electrolytes and metabolites of healthy horses are given.

Animals↗
PubMed1981

Studies on kidney function in subjects exposed to organic solvents. I. Excretion of albumin and beta-2-microglobulin in the urine.

The urine of 134 subjects, exposed to different organic solvents, and 48 unexposed subjects has been analysed with reference to albumin and beta-2-microglobulin excretion. The exposed subjects excreted significantly larger quantities of albumin than the unexposed. Those exposed to styrene excreted the largest amounts. No significant difference in beta-microglobulin excretion could be demonstrated between the groups.

Adult↗
PubMed2006

The effects of paracetamol and parecoxib on kidney function in elderly patients undergoing orthopedic surgery.

The common adverse effects of traditional nonsteroidal antiinflammatory drugs on renal function include reductions in renal blood flow, glomerular filtration rate, and sodium and potassium excretion, mainly via inhibition of renal cyclooxygenase. We designed the present study to determine the effects of IV paracetamol or parecoxib on renal function in elderly patients undergoing orthopedic surgery. Seventy-five patients (76 +/- 8 yr, mean +/- sd) undergoing hip replacement or surgery of the femoral shaft completed this randomized and placebo-controlled study. After their arrival in the postanesthesia care unit, patients received an initial dose of the study medication, paracetamol 1000 mg IV (n = 25), parecoxib 40 mg IV (n = 25), or saline IV (n = 25); subsequent doses were administered for the next 3 days. Opioids were provided as rescue medication. Blood and urine samples were collected before and after surgery, and markers of renal function were determined. During the first 2 h after the initial dose of parecoxib, creatinine clearance was slightly diminished (125 +/- 83 to 86 +/- 45 mL/min, P < 0.05), whereas no significant decrease of creatinine clearance was observed in the placebo and paracetamol groups. After all treatments, sodium and potassium excretion as well as urine albumin and alpha-1-microglobulin were transiently increased (group differences: not signicifant). In conclusion, glomerular and tubular functions were transiently affected in all patients after orthopedic surgery; however, the differences between the treatment groups were small and not clinically relevant. Further studies are warranted to determine adverse renal effects of longer-lasting therapy with these drugs, especially in patients with renal impairment or concomitant diseases.

Acetaminophen↗
PubMed1977

Total and individual kidney function assessment with iodine-123 ortho-iodohippurate.

A simple and reliable method of preparing 123l o-iodohippurate (l-123 OIH) is described. The agent was used to evaluate renal function in 329 patients; its use results in significant dose reduction for those with obstruction, hypertension, or transplant. Images from l-123 OIH provide 2.4 times more detectable photons per mCi administered to the patient than images obtained from l-131 OIH. Diagnoses are expected to be more reliable with l-123 OIH due to the decreased random variation of each data point.

Adult↗
PubMed2006

Effect of vitamin C on liver and kidney functions in normal and diabetic rats.

Diabetes mellitus (DM) is recognized as one of the leading causes of morbidity and mortality in the world. About 5-6% of the world population suffers from this disease and the number of people diagnosed with diabetes is rapidly increasing. Diabetes has been demonstrated to be associated with oxidative stress and hyperglycemia, one of the most important indicators of oxidative stress. The endogenous mechanisms of enzymes and antioxidants are able to destroy the reactive species and create a balance between antioxidant and free radicals. In diabetes, the oxidative stress is increased because of the deficiency in the antioxidant defense. The intake of antioxidants, such as vitamin C, may reduce the oxidative stress associated with diabetes and hence help to restore the antioxidant defense system. The aim of this article was to investigate the effect of different doses of vitamin C on the biochemical parameters of normal and streptozotocin (STZ)-induced diabetic rats. Biochemical analysis was used to study the effect of this vitamin on the biochemical parameters of normal and diabetic rats. Liver and kidney enzymes were elevated after the onset of diabetes. Moderate doses of vitamin C significantly (P < 0.0008) reduced plasma gamma-glutamyl level in diabetic rats. Moreover, vitamin C significantly (P < 0.01) reduced the blood urea nitrogen level of diabetic rats. The plasma level of electrolytes, such as calcium and sodium, also changed significantly (P < 0.00001) after oral administration of vitamin C. Antioxidants, such as vitamin C, may ameliorate the biochemical parameters of diabetic rats.

Alanine Transaminase↗
PubMed1984

[Studies and results of the use of nuclear medicine methods in kidney function tests].

It is sought for alternative methods for the endogenous creatinine clearance as parameters for the GFR. For this purpose served investigations with Tc-99m-Sn-DTPA. It was found a good reproducibility for the slope clearance with 3 blood takings between 60 and 120 minutes. When combined with the camera function scintigraphy a side-separated quantitative statement of the clearance equivalent is possible. The inulin clearance serves as reference method. The investigations at the gamma-camera with Tc-99m-Sn-DTPA also allow the determination of the perfusion which is particularly of interest in patients with hypertension. According to the comparison at the gamma camera a diagnostic schema is recommended.

Adult↗
PubMedDate not supplied

[The diagnostic significance of enzymuria in assessing kidney function in patients with urolithiasis].

Urinary levels of L-, Y-glutamyl transferase, alkaline phosphatase, L-leucine arylaminidase, lactate dehydrogenase, N-acetyl-beta-D-glucose aminidase, pseudocholine esterase, neutral L-glucosidase were examined in 76 urolithiasis patients. The activity of the above enzymes was found enhanced. This may be due to dysfunction of the tubular system. The content of L-leucine arylaminidase, N-acetyl-beta-D-glucose aminidase, L-glucosidase provide the most complete diagnostic information compared to the other enzyme tests.

Adult↗
PubMed1987

[Changes in renal protein excretion and kidney function in type I diabetic patients during and following pregnancy in relation to the stage of preexistent diabetic nephropathy].

In 14 female type I diabetics the influence of preexisting diabetic nephropathy on the behaviour of proteinuria and renal function during and after pregnancy was investigated. We compared albumin and total protein in urine, serum-creatinine, creatinine-clearance, uric acid and beta 2-microglobulin in serum before, during and up to sixth months after pregnancy in 5 diabetic women with preexisting normo-albuminuria, stage II of diabetic nephropathy, in 6 women with microalbuminuria, stage III, and in 3 women with overt proteinuria, stage IV of diabetic nephropathy (by Mogensen); in this last patient-group there was a heavy proteinuria with decreased creatinine clearance and high blood pressure still before the begin of the pregnancy. The albumin- and total protein excretion in urine showed in all diabetic patients a 3- to 8-fold increase during pregnancy and in all cases the increased proteinuria dropped after pregnancy to the preexisting values. A transient nephrotic syndrome in pregnancy developed in 2/6 diabetic women with primary microalbuminuria and in all 3 patients with overt proteinuria, but not in any case of pregnant women with primary normo-albuminuria; the difference between the absolute increase of proteinuria in the 2 patient-groups with stage II and III of diabetic nephropathy was statistically significant (p less than 0.005). The renal function parameters serum-creatinine and creatinine-clearance showed in all pregnant women with stage II or III of diabetic nephropathy the same transient changes as in non-diabetic pregnant women, the mean serum-creatinine concentration showed a decline of 36% respectively 14%, the creatinine clearance an increase of 31% and 36%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Radionuclide kidney function evaluation in the management of urolithiasis.

Renal and ureteral stones may cause asymmetrical renal damage that is not measured accurately by serum creatinine and blood urea nitrogen studies, excretory urography, nephrotomography and arteriography. We evaluated with a renal scintillation camera study 77 patients who had renal or ureteral calculi. The radionuclide procedure provided an accurate measure of total effective renal plasma flow and differential effective renal plasma flow. It had the additional advantages of being a non-invasive procedure, causing no allergic reactions, requiring no patient preparation and producing low radiation exposure.

Adult↗
PubMed1986

[Kidney function in lead burden].

Renal failure as a consequence of manifest lead intoxication (nephropathia saturnina) has almost completely disappeared in the FRG. However, there has been rising concern that increased lead burden, primarily as a result of environmental pollution, may adversely affect blood pressure and renal function even in the absence of extrarenal signs of lead intoxication. Such concern is based on epidemiological studies which demonstrated a relation between blood lead level and blood pressure and on experimental studies which showed that lead activates several pressor mechanisms. Furthermore, increased body lead burden is found in a substantial proportion of patients with renal failure, particularly when concomitant gout is present. Unfortunately, none of the above findings constitute irrefutable evidence and further studies are clearly necessary.

Calcium↗
PubMed1987

[Cardiovascular operations in patients with perioperative reduced kidney function].

Acute renal failure (ARF) following cardiovascular surgery represents a serious complication in view of the multimorbidity in such patients. 8 out of 16 patients with ARF requiring hemodialysis after cardiac surgery died; the degree of preoperative renal insufficiency could not be recognized as predisposing factor. 17 out of 21 patients with ARF following aortic vascular surgery died; the severity of the preoperative disease seems to be of prognostic value. Open heart surgery had to be performed in 9 patients out of the chronic dialysis program; perioperative complications did not occur, suggesting that cardiovascular operations can be performed without increased risk in this patient group.

Acute Kidney Injury↗