Inledning: Undersökningar som inkluderar kontrastmedel har ökat på datortomografin (DT). Inför kontrastmedelsundersökningar ska den glomerulära filtrationshastigheten (GFR) estimeras för att få ett mått på patientens njurfunktion. I nuläget finns det två olika markörer som kan användas till detta, kreatinin och cystatin C. Det är röntgensjuksköterskans ansvar att skatta GFR för att kunna göra en bedömning om patienten kan utföra undersökningen. Syfte: Syftet med studien var att sammanställa studier som jämför kreatinin och cystatin C vid skattning av GFR. Metod: Den här studien genomfördes som en allmän litteraturöversikt. Litteratursökningen genomfördes i databaserna CINAHL, PubMed och SveMed+. Tio kvantitativa vetenskapliga artiklar lokaliserades och gick vidare till analys. Resultat: Resultatet visade att cystatin C i många fall var en bättre indikator för att estimera GFR. Slutsats: För äldre och njursjuka ansågs cystatin C vara en bättre markör för njurfunktionen. Dock anser författarna att det krävs vidare forskning inom ämnet och dess påverkande faktorer för att kunna introducera cystatin C som ny njurfunktionsmarkör.

Introduktion: Jodbaserade kontrastmedel används på sjukhus som nyttjar en datortomografisk kamera, då dess syfte är att förstärka frisk och sjuk vävnad. Då kontrastmedel används frekvent, är det viktigt att ha rätt dosering. Enligt rekommendationer skall doseringen anpassas beroende på patientens njurvärde (GFR), ålder, vikt och längd. Trots rekommendationerna så använder sjukhus olika doser trots undersökningen gäller en och samma patient. Metod: En enkät distribuerades ut till 49 sjukhus via mejl för att samla in dosanvändning av intravenöst kontrastmedel på en datortomografisk bukundersökning. Ett total av 33 sjukhus medverkade i svarsinsamlingen (67%), som inkluderade 3 universitetssjukhus, 11 länssjukhus, 17 länsdelssjukhus och 2 anonyma sjukhus. Enkäten gjordes via esMaker och innehöll två fiktiva patientfall, och fem frågor gällande sjukhusens datortomografiska kamera, samt deras beräkningssystem av kontrastmedel. Syfte: Undersöka skillnader i kontrastmedelsanvändning vid datortomografiska bukundersökningar. Resultat: Patientfall 1 hade en kontrastmedelsdos mellan 84–120 ml, medan patientfall 2 visade en variation mellan 66–96 ml. aGFR användes hos 52% av sjukhusen för uträkning av kontrastmedel, 27% använde rGFR och 21% använde en kombination av båda. Slutsats: Det finns en skillnad i doseringen av jodkontrastmedel på olika sjukhus runtom i Sverige. / Introduction: Iodine-based contrast agents are used in hospitals equipped with a computed tomographic camera, as their purpose is to enhance both healthy and diseased tissue. As contrast agents are used frequently, it is important to use the correct dosage. According to recommendations, the dosage should be adjusted depending on the patient’s kidney function (GFR), age, weight, and height. Despite the recommendations, hospitals use different doses even though the examination concerns the same patient. Methods: A survey was out to 49 hospitals via email to collect information on the dosage of intravenous contrast agents in computed tomographic abdominal examinations. A total of 33 hospitals participated in the data collection (67%), including 3 university hospitals, 11 district hospitals, 17 county hospitals and 2 anonymous hospitals. The survey was conducted using esMaker and included two fictitious patient cases, and five questions regarding their computed tomographic camera and their calculations system. Objectives: To investigate differences in the usage of contrast agents in computed tomographic abdominal examinations. Results: Patient case 1 had a contrast agents dose ranging from 84–120 ml, while patient case 2 showed a variation between 66–96 ml. Absolute GFR were used in 53% of the hospitals for calculating the contrast agent dosage, 27% used relative GFR, and 21% used a combination of both. Conclusions: There is a variation in the dosage of contrast agents used in different hospitals across Sweden.

<p>Several studies have reported beneficial effects of C-peptide supplementation in diabetic patients and animal models of insulinopenic diabetes. However, it is also established that good glycemic control is essential to minimize the risk of diabetes-induced complications. This thesis investigates potential mechanisms for the beneficial effect of C-peptide on glomerular hyperfiltration, and a novel, painless route of insulin administration.</p><p>The results demonstrate that both C-peptide and its C-terminal penta-peptide sequence reduce the diabetes-induced glomerular hyperfiltration within an hour. The results also indicate that C-peptide possibly reduces diabetes-induced hyperfiltration via three different mechanisms: 1. Constriction of the afferent arteriole was demonstrated on isolated vessels from diabetic mice. 2. A net dilation of the efferent arteriole was evident <i>in vivo</i>. 3. Inhibition of the Na⁺/K⁺-ATPase was demonstrated <i>in vivo</i> in diabetic rats as well as <i>in vitro</i> on isolated proximal tubular cells from diabetic rats. All these mechanisms are known regulators of the net glomerular filtration pressure.</p><p>The last part of this thesis demonstrates that intradermal administration with a newly developed patch-like microneedle device results in similar insulin concentration compared to standard subcutaneous delivery. </p><p>These findings provide an insight for the beneficial effects of C-peptide on diabetic kidney function, and shows that this effect can be achieved by infusion of the C-terminal penta-peptide sequence alone. This thesis also presents a novel, painless alternative to insulin injections that is controllable, requires minimal training, and therefore presents several advantages compared to current standard therapy.</p>

Live kidney donors are healthy volunteers who are exposed to major surgical procedure and physical harms with no direct therapeutic benefits. Efforts to minimize their risks and morbidity are therefore of utmost importance. The current thesis describes studies on donor evaluation, surgical procedure and postoperative management of live kidney donors. The overall purpose is to evaluate and possibly improve routines and treatments in order to reduce risks and the overall morbidity of live kidney donors. In Study I, we evaluated the assessment of kidney function during donor evaluation and found that the accuracy of iohexol glomerular filtration rate (GFR) is compromised by large variations in repeated measurements in presumably healthy donors. We proposed that there is a need for improvement of GFR measurements and that the assessment of predonation kidney function should be more comprehensive, involving GFR, laboratory investigations, functional and morphological examinations and sound clinical judgment. In Study II, we addressed the risk of perioperative venous thromboembolism (VTE) and concluded that expanding the standard screening protocol for VTE to include perioperative venous duplex can potentially decrease the VTE-related morbidity. In studies III and IV, we investigated the impact of hand-assisted retroperitoneoscopic (HARS) nephrectomy on donor safety and perioperative morbidity. The HARS nephrectomy uses the hand-assisted approach, which enables immediate manual compression for hemostasis in case of sudden and severe bleeding. Additionally, the pure retroperitoneal access further increases the safety margin of laparoscopic donor nephrectomy by 1) minimizing the risk of intestinal injury, and 2) exposure of the retroperitoneal nerves, making HARS suitable for continuous infusion of local anesthetics (CILA). CILA effectively reduces the need for opioid consumption and has the potential to totally obviate opiate analgesics postoperatively. Consequently, CILA in combination with HARS reduces morphine-related morbidity and promotes postoperative recovery. In accordance with these data, we recommend improvement and modification of the donor evaluation process as well as a broad introduction of HARS nephrectomy in combination with CILA to increase the safety margin for live kidney donors.

Several studies have reported beneficial effects of C-peptide supplementation in diabetic patients and animal models of insulinopenic diabetes. However, it is also established that good glycemic control is essential to minimize the risk of diabetes-induced complications. This thesis investigates potential mechanisms for the beneficial effect of C-peptide on glomerular hyperfiltration, and a novel, painless route of insulin administration. The results demonstrate that both C-peptide and its C-terminal penta-peptide sequence reduce the diabetes-induced glomerular hyperfiltration within an hour. The results also indicate that C-peptide possibly reduces diabetes-induced hyperfiltration via three different mechanisms: 1. Constriction of the afferent arteriole was demonstrated on isolated vessels from diabetic mice. 2. A net dilation of the efferent arteriole was evident in vivo. 3. Inhibition of the Na+/K+-ATPase was demonstrated in vivo in diabetic rats as well as in vitro on isolated proximal tubular cells from diabetic rats. All these mechanisms are known regulators of the net glomerular filtration pressure. The last part of this thesis demonstrates that intradermal administration with a newly developed patch-like microneedle device results in similar insulin concentration compared to standard subcutaneous delivery. These findings provide an insight for the beneficial effects of C-peptide on diabetic kidney function, and shows that this effect can be achieved by infusion of the C-terminal penta-peptide sequence alone. This thesis also presents a novel, painless alternative to insulin injections that is controllable, requires minimal training, and therefore presents several advantages compared to current standard therapy.

This paper describes the design of the ventilation pressure cover of the demonstrator GFR. The first part is a brief research project GFR and the effects of temperature on the inside structures. In the following part is calculated balance heat losses within the pressure cover for three cases: non-insulated, fully-insulated and partially insulated surface of the reactor. The following is a design of a heat sink for partially insulated surface.

The thesis aimed to investigate cystatin C and creatinine-based estimates of glomerular filtration rate (eGFR), both at admission and during follow-up, on the combined endpoint of cardiovascular death and myocardial infarction in patients with acute coronary syndrome (ACS). We also evaluated two cystatin C assays and assessed genetic determinants of cystatin C concentrations. We used the PLATelet inhibition and Patient Outcomes study, where all types of ACS patients (n=18624) were randomized to ticagrelor or clopidogrel treatment. Multivariable Cox regression models, including clinical variables and biomarkers (troponin and NT-proBNP), and c-statistics were calculated. Cystatin C and the creatinine-based CKD-EPI equation exhibited similar significant prognostic impact on the combined endpoint, with Area Under Curves (AUC) 0.6923 and 0.6941, respectively. Follow-up samples of renal biomarkers did not improve risk prediction. Patients randomized to ticagrelor treatment were associated with a non-sustained larger increase in renal markers at discharge, but neither the change nor the difference between the randomized groups affected cardiovascular risk. Two different cystatin C assays exhibited good correlation 0.86 (95% confidence interval 0.85-0.86), however moderate level of agreement. Risk prediction with a combination of creatinine and cystatin C did not outperform the creatinine-based CKD-EPI equation, AUC: 0.6913 and 0.6924, respectively (n=13050). The genetic polymorphism rs6048952 independently affected the cystatin C concentration with mean levels of 0.85mg/L, 0.80mg/L and 0.73mg/L for the A/A, A/G, and G/G genotypes, respectively. The genetic polymorphism did not affect outcome overall, however in the non-ST-elevation ACS subgroup a signal that genetic polymorphism may be associated with cardiovascular death was observed (p=0.002). In conclusion: cystatin C or eGFR, irrespective of equation or assay, are important cardiovascular risk factors in ACS patients. Nonetheless, the incremental value of adding any renal variable, to a multivariable risk model, is small. Further research on the impact of cystatin C genetic polymorphism is warranted. / <p>PhD, i medicin.</p>

Objective of the work: The purpose of this quantitative retrospective comparative study was to register possible cases of augmentedted renal clearance (ARC) in patients of Hospital of Lithuanian University of Health Sciences and analyse the differences in assessments of cases of Augmented Renal Clearance and the drug therapy problems related to ARC. Tasks: To achieve the objective, several tasks were performed: 1) to register possible ARC patients cases as assessed by Cocroft-Gault and their possible associated reasons; 2) to analyse differences in three equations used for GFR estimation: Cocroft-Gault, MDRD simplified, and CKD-EPI. 3) compare the therapies of the patients and determine the drugs that are in risk of being underdosed when ARC is present. Methodology: An ARC survey (appendix 1) was filled about patients from various departments of Clinics during the period of 2013 03 04 – 2014 08 15. All patients were selected according serum creatinine values that were 50 µmol/l. or less. Two goups of patients were assigned for analysis: patients were grouped according Cocroft - Gault creatinine clearance values: (1) ARC group A CrCl >130 ml./min and (2) comparative Non-ARC group B CrCl 90-130 ml./min. Data were analyzed by using descriptive and comparative statistical analysis, considering statistically significant difference between the groups if p value was <0.05. Results and conclusions: 1. In the research group and comparative groups were 31 patients selected... [to full text] / Darbo tikslas: Šio kiekybinio retrospektyvaus palyginamojo darbo tikslas buvo surinkti duomenis apie padidinto inkstų klirenso PIK atvejus Lietuvos sveikatos mokslų universiteto ligonines Kauno klinikose. Buvo siekiama išanalizuoti sirtumus tarp skirtingų PIK įvertinimo būdų ir įvertinti galimas su PIK susijusias terapijos problemas. Uždaviniai: norint pasiekti užsibrėžtus tikslus šie uždaviniai buvo iškelti: 1) užregistruoti PIK atvejus ir nustatyti jų galimas priežastis. 2) apskaičiuoti GFG trimis skirtingomis formulėmis (Cocroft-Gault, MDRD, CKD-EPI) ir išanalizuoti skirtumus. 3) palyginti pacientų terapijas ir nustatyti, kurie vaistai galimai yra subterapinio dozavimo rizikoje Metodika: PIK anketa ( 1 priedas) buvo pildoma apie pacientus iš skirtingų Kauno klinikų skyrių, laikotarpiu nuo 2013 03 04 iki 2014 08 15. Visi pacientai buvo parinkti pagal kreatinino kiekį serume – 50 μmol/l.. ir mažiau. Dvi pacientų grupės buvo parinktos analizei: pacientai buvo sugrupuoti pagal kreatinino klirensą į (1) PIK A grupę – CrCl > 130 ml./min. ir (2) palyginamąją B grupę – CrCl 90-130 ml./min. Duomenys buvo analizuojami naudojant palyginamąją ir aprašomąją statistiką. Skirtumai tarp grupių buvo laikomi statistiškai reikšmingi, kai p reikšmė buvo <0.05. Rezultatai ir išvados: 1. Abiejose grupėse buvo surinkta po 31 pacientą (iš viso 62 pacientai). Remiantis darbo rezultatais, galima daryti išvadą, kad PIK (kai GFG yra 130ml/min. ir daugiau) nustatymui naudojant Cocroft-Gault formulę... [toliau žr. visą tekstą]

In recent years, the focus on augmented renal clearance increased as it was found by other researchers to result in subtherapeutic drug dosing concentrations. Accurate assessment of renal function is important for prescribing optimal dosis of pharmaceuticals for ARC patients. Objective of the work: The purpose of this quantitative retrospective comparative study was to register possible cases of Accelerated renal clearance in patients of Hospital of Lithuanian University of Health Sciences Kaunas Clinics and analyse the differences in assessments of cases of Augmented Renal Clearance and the possible risks of ARC for therapy. Tasks: To achieve the objective several tasks were raised: 1) to register possible ARC patients cases as assessed by Cocroft-Gault and their possible associated reasons; 2) to analyse differences in three for GFR estimation used equations (Cocroft-Gault, MDRD simplified, and CKD-EPI). 3) determine the risk drugs for changed renal elimination. Methodology: ARC survey (appendix 1) was filled about patients from various departments of Clinics during the period of 2013 03-04 – 2013 12-20. All patients were selected according serum creatinine values that were 50 µmol/l. or less. Two goups of patients were assigned for analysis: patients were grouped according Cocroft - Gault creatinine clearance values: (1) ARC group A CrCl >130 ml./min and (2) comparative Non-ARC group B CrCl 90-130 ml./min. In the group A were 31 and in the group B - 5 patients... [to full text] / Pastaraisiais metais labai išaugo tyrimų apie padidintą inkstų klirensą (PIK), nes pagal keleto tyrejų duomenis šios būklės pasekmė yra subterapinės vaistų koncentracijos. Tikslus inkstų funkcijos nustatymas yra labai svarbus norint parinkti optimalias terapines vaistų dozes padidinto inkstų klirenso pacientams. Darbo tikslas: Šio kiekybinio retrospektyvaus palyginamojo darbo tikslas buvo surinkti duomenis apie padidinto inkstų klirenso PIK atvejus Lietuvos sveikatos mokslų universiteto ligonines Kauno klinikose. Buvo siekiama išanalizuoti sirtumus tarp skirtingų PIK įvertinimo būdų ir įvertinti galimas PIK rizikas terapijai Uždaviniai: norint pasiekti užsibrėžtus tikslus šie uždaviniai buvo iškelti: 1) užregistruoti PIK atvejus ir nustatyti jų galimas priežastis. 2) apskaičiuoti GFG trimis skirtingomis formulėmis (Cocroft-Gault, MDRD, CKD-EPI) ir išanalizuoti skirtumus. 3) nustatyti vaistus, kurie gali būti pakitusios inksų eliminacijos rizikoje. Metodika: PIK anketa ( 1 priedas) buvo pildoma apie pacientus iš skirtingų Kauno klinikų skyrių, laikotarpiu nuo 2013 04 03 iki 2013 12 20. Visi pacientai buvo parinkti pagal kreatinino kiekį serume – 50 µmol/l.. ir mažiau. Dvi pacientų grupės buvo parinktos analizei: pacientai buvo sugrupuoti pagal kreatinino klirensą į (1) PIK A grupę – CrCl > 130 ml./min. ir (2) palyginamąją B grupę – CrCl 90-130 ml./min. A grupėje buvo parinktas 31 pacientas ir B grupėje 5 pacientai. Rezultatai: Vidutinės GFG reikšmės tiriamojoje... [toliau žr. visą tekstą]

No description available.