Bakgrund: För estimering av glomerulär filtrationshastighet (eGFR) behövs ett blodprov, såsom kreatinin eller cystatin C. En av röntgensjuksköterskans arbetsuppgifter är skattning av GFR innan jodkontrastmedel administreras, på grund av risken för njurbiverkningar. Hos äldre patienter är känsligheten för läkemedel påtaglig på grund av förändrad farmakokinetik. Osäkerhet råder om vilket blodprov som ger noggrannast eGFR.  Syfte: Syftet med studien var att genom litteraturgenomgång undersöka hur markörerna kreatinin respektive cystatin C skattar eGFR hos äldre patienter. Metod: Syftet besvarades av en litteraturstudie med resultat från åtta kvantitativa studier. De ingående studierna analyserades och sammanställdes. Databassökningarna utfördes i PubMed och Cinahl. Resultat: Resultatet visade att skattningarna av eGFR kunde skilja sig signifikant mellan kreatinin och cystatin C, medan andra gånger var de mer liknande. Vid stigande ålder ökade skillnaden mellan skattningarna av eGFR med de två markörerna. Konklusion:  Varken kreatinin eller cystatin C är optimalt. Delar av resultatet pekade mot att kombinationen kan vara en fördel. Mer forskning behövs inom området. / Background: When estimating glomerular filtration rate (eGFR), a blood test is required, such as creatinine or cystatin C. One of the radiographers' assignments is to estimate GFR before administering iodinated contrast agents, due to the risk of renal side effects. In elderly patients, the sensitivity to drugs is palpable due to altered pharmacokinetics. There is uncertainty about which blood test produces the most accurate eGFR. Aim: The aim was to investigate through a literature review how the markers creatinine and cystatin C estimate eGFR in elderly patients. Methods: The aim was answered by a literature study with results from eight quantitative studies, that were found in the databases PubMed and Cinahl. All included studies were analyzed and compiled. Results: The results showed that the estimates of eGFR could differ significantly between creatinine and cystatin C, while other times they were more similar. With an increasing age the two markers showed a larger difference in estimation of GFR. Conclusion: Neither creatinine nor cystatin C is optimal. Parts of the results indicated that the combination may be an advantage. More research is needed in this area.

Feline morbilliviruses (FeMV) are fairly newly discovered paramyxoviruses found in cats. The first description indicated an association with widely distributed chronic kidney disease (CKD) in the host species. In various studies, a global prevalence and a further genotype, designated FeMV-2, and the involvement of other organ systems in infected individuals were shown. Using an immunofluorescence assay, we detected an overall seroprevalence of FeMV in almost half of the cats investigated (n = 380), with a significantly increased proportion in younger animals. In comparison to European Shorthair cats, the rate of seropositivity is higher in pedigree cats. Regardless of the breed, FeMV infection was associated with increased blood creatinine concentrations, suggesting an association with CKD. Further analysis indicated that this association was the strongest in animals having high IFA titers against FeMV-2. In addition, a significant association between FeMV-positive status and the prevalence of feline lower urinary tract disease (FLUTD, or idiopathic cystitis) was detected. This association was dominated by cats having antibodies against FeMV-1 only. To further evaluate the positive correlation between FeMV seroprevalence and CKD as well as FLUTD, consideration of additional clinical characteristics and laboratory parameters is warranted, and controlled infection studies with both FeMV genotypes are necessary. Clinicians should, however, be aware of a possible link between renal and lower urinary tract disease and FeMV infections.

Yes / Acute kidney injury (AKI) can occur rarely in patients exposed to iodinated contrast and result in contrast-induced AKI (CI-AKI). A key risk factor is the presence of pre-existing chronic kidney disease (CKD), therefore it is important to assess patient risk and obtain kidney function measurement prior to administration. Point of care (PoC) testing provides an alternative strategy but there remains uncertainty, with respect to diagnostic accuracy and clinical utility. A device study compared three PoC analysers (Nova StatSensor, Abbott i-STAT, Radiometer ABL800 FLEX) with a reference laboratory standard (Roche Cobas 8000 series, enzymatic creatinine). Three hundred adult patients attending a UK hospital phlebotomy department were recruited to have additional blood samples for analysis on the PoC devices. The ABL800 FLEX had the strongest concordance with laboratory measured serum creatinine (mean bias=-0.86, 95% limits of agreement = -9.6 to 7.9) followed by the i-STAT (average bias=3.88, 95% limits of agreement = -8.8 to 16.6) and StatSensor (average bias=3.56, 95% limits of agreement = -27.7 to 34.8). In risk classification, the ABL800 FLEX and i-STAT identified all patients with an eGFR≤30, whereas the StatSensor resulted in a small number of missed high-risk cases (n=4/13) and also operated outside of the established performance goals. The screening of patients at risk of CI-AKI may be feasible with PoC technology. However in this study it was identified that the analyser concordance with the laboratory reference varies. It is proposed that further research exploring PoC implementation in imaging department pathways is needed. / Yorkshire and Humber Academic Health Science Network (Grant Number: YHP0318)

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.

Submitted by Carvalho Dias João Paulo (joao.dias@famerp.br) on 2018-04-11T14:07:04Z No. of bitstreams: 1 cristinaprataamendola_tese.pdf: 1747743 bytes, checksum: fc59212f08f91c7ebb7d3109288f9673 (MD5) / Made available in DSpace on 2018-04-11T14:07:04Z (GMT). No. of bitstreams: 1 cristinaprataamendola_tese.pdf: 1747743 bytes, checksum: fc59212f08f91c7ebb7d3109288f9673 (MD5) Previous issue date: 2017-02-06 / Introduction: Acute kidney injury (AKI) is observed in a substantial proportion of patients admitted to intensive care unit and is a significant predictor of poor outcomes. The management of hemodynamic and oxygenation parameters, known as goal-directed therapy (GDT), may prevent AKI, however, it is not known if this treatment strategy can mitigate renal impairment or decrease mortality in patients with early AKI. Background: To assess whether GDT promoted in the early stage of AKI can change AKI course. Material and Methods: This was a prospective, randomized, controlled, and multicenter study carried out in the Intensive Care Unit. Patients with early AKI were randomly allocated to a standard care (Control) or GDT group with 8-h intensive treatment to maximize oxygen delivery. The two groups were monitored until hospital discharge or death. Results: A total of 143 patients were eligible and 99 patients were randomized either of the two groups. In the GDT group, central venous oxygen saturation (ScvO2) significantly increased and serum lactate significantly declined (p = 0.001) compared with the Control group (p = 0.572). A lactate clearance higher or equal 10% during GDT was associated with a significant decrease in the odds of death (OR 0.37 IC 95% 0.14-0.97, p=0.044). There was no difference in SCr difference (p=0.96) or the need for renal replacement therapy between groups (p = 0.82). In-hospital mortality was significantly decreased in the GDT group (33% vs. 51%; RR: 0.61, CI 95% 0.37−1.00, p = 0.048, Number needed to treat = 5). Conclusion: GDT in patients with early AKI did not change AKI course but it seems to determine better survival. / Introdução: A Injúria Renal Aguda (IRA) é observada em uma proporção substancial de pacientes admitidos em UTI. O manejo intensivo dos parâmetros hemodinâmico e de oxigenação, como a Terapia Dirigida por Metas (TDM), pode prevenir a IRA, no entanto, não está claro se essa estratégia de tratamento é capaz de atenuar a piora da função renal ou diminuir a mortalidade em pacientes com IRA precoce. Objetivo: Avaliar se a TDM iniciada em estágio precoce da IRA pode promover uma mudança na sua evolução. Materiais e Métodos: Tratou-se de um estudo multicêntrico, prospectivo, randomizado, controlado, desenvolvido em UTI. Pacientes com IRA precoce foram randomizados e divididos em dois grupos, um grupo foi submetido a terapia padrão (Controle) e o outro a um tratamento intensivo guiado por uma TDM durante oito horas no intuito de maximizar a oferta de oxigênio. Os dois grupos foram monitorados até a alta hospitalar ou óbito. Resultados: Um total de 143 pacientes foram elegíveis para o período do estudo e 99 pacientes foram randomizados para um dos dois grupos. No grupo TDM, a saturação venosa central de oxigênio (SvcO2) aumentou significativamente e o lactato sérico diminuiu significativamente em relação ao basal (p = 0,001) comparado com o grupo Controle (p = 0,572). Um clareamento de lactato sérico maior ou igual a 10% durante a TDM associou-se a uma diminuição significativa da chance de morte (OR 0,37 IC 95% 0,14-0,97, p=0,044). Não houve diferença na comparação entre as medidas de creatinina sérica (p=0,96) ou na necessidade de hemodiálise entre os dois grupos (p = 0,82). A mortalidade hospitalar diminuiu significativamente no grupo TDM (33% vs. 51%; RR: 0,61, CI 95% 0,37−1,00, p = 0,048, Número Necessário para Tratar = 5). Conclusão: A TDM não modificou a evolução para IRA, mas pode ter determinado melhor sobrevida por provável melhora da perfusão tecidual.

Submitted by Verônica Esteves (vevenesteves@gmail.com) on 2017-09-27T17:47:16Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ACURÁCIA DA CREATININA DOSADA EM GOTA DE SANGUE SECA EM PAPEL DE FILTRO PARA RASTREAMENTO DA DOENÇA RENAL CRÔNICA.pdf: 840099 bytes, checksum: e1a6a3188e8d5575446207666d1aac97 (MD5) / Approved for entry into archive by Verônica Esteves (vevenesteves@gmail.com) on 2017-09-27T17:51:13Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ACURÁCIA DA CREATININA DOSADA EM GOTA DE SANGUE SECA EM PAPEL DE FILTRO PARA RASTREAMENTO DA DOENÇA RENAL CRÔNICA.pdf: 840099 bytes, checksum: e1a6a3188e8d5575446207666d1aac97 (MD5) / Made available in DSpace on 2017-09-27T17:51:13Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ACURÁCIA DA CREATININA DOSADA EM GOTA DE SANGUE SECA EM PAPEL DE FILTRO PARA RASTREAMENTO DA DOENÇA RENAL CRÔNICA.pdf: 840099 bytes, checksum: e1a6a3188e8d5575446207666d1aac97 (MD5) Previous issue date: 2015 / Consultório / A identificação precoce da doença renal crônica (DRC) em populações de risco é preconizada devido à elevada morbidade e mortalidade dessa patologia. O rastreamento é normalmente feito utilizando testes de baixo custo e pouco invasivos, como a detecção de albumina na urina ou a dosagem da creatinina sérica. Apresentamos nesse estudo uma forma alternativa inovadora e de simples execução para dosar a creatinina. Cento e seis pessoas com alto risco de desenvolverem DRC foram envolvidas. A idade dos participantes foi de 57 ± 12 anos, 78 (73,5%) eram do sexo feminino, 43 eram brancos (40,5%), 36 eram pardos (34%) e 27 negros (25,5%). Setenta e seis por cento alegaram serem hipertensos, 30% já sabiam ter diabetes, 37% disseram ter história familiar para DRC e 22% eram tabagistas. O índice de massa corpórea (IMC) foi de 29,5 ± 6,9 kg/m2, a pressão arterial sistólica foi de 125 mmHg (intervalo interquartil [IQR] 120-140 mmHg) e a pressão arterial diastólica de 80 mmHg (IQR 70-80 mmHg). A validade do teste feito com papel filtro foi calculada considerando como a variável de interesse uma taxa de filtração glomerular estimada menor que 60/ml/min/1,73m2, calculado pelas equações MDRD e CKD-EPI. Desta maneira, a sensibilidade do PF foi de 96% na equação MDRD e de 94% na CKD-EPI. O valor preditivo positivo foi de 96% para ambas equações. A acurácia mostrou um desempenho de 92% na MDRD e de 90% na CKD-EPI. O método de Bland e Altman mostrou que os valores de creatinina entre os dois testes estão numa faixa relativamente estreita (+0.68 mg/dL a -0.55 mg/dL) para um desvio padrão de ±1.96. Concluímos que a dosagem da creatinina em papel filtro é um teste pouco invasivo e apresentou um bom desempenho para rastrear a DRC. / Chronic kidney disease (CKD) screening is advisable in populations with risk factors for chronic kidney disease due to its high morbidity and mortality. It´s usually performed by sampling blood for creatinine and urine for albuminuria. Here we present an innovative and simpler method, by measuring creatinine in a dry blood spot on filter paper. One-hundred and six individuals at high risk for CKD were enrolled. Mean age was 57±12 years, 74% were female, 40% white, and 60% non-white. Seventy-six percent were hypertensive, 30% diabetic, 37% had family history of CKD, and 22% of smoking. The BMI was 29.5 ± 6.9 kg/m2, median systolic blood pressure was 125 mmHg (IQR 120-140 mmHg) and median diastolic blood pressure was 80 mmHg (IQR 70-80 mmHg). Adopting CKD with the found of a e_GFR60/ml/min/1,73m2 for MDRD and CKD-EPI equation, the sensitivity was 96% for MDRD and 94% in CKD-EPI. The positive predictive value was 96% for both equations. The accuracy was 92% in MDRD and 90% for CKD-EPI. . A Bland and Altman analysis showed a relatively narrow range of creatinine values differences (+0.68 mg/dL to -0.55 mg/dL) inside the ±1.96 SD, without systematic differences. Accordingly, the minimally invasive dry blood spot creatinine measurement disclosed good performance, and may be useful as a screening tool for CKD.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-28T14:52:18Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertação roberto barcellos.pdf: 945783 bytes, checksum: 7e1ee727b4082901916d30284acd2e19 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-28T14:52:43Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertação roberto barcellos.pdf: 945783 bytes, checksum: 7e1ee727b4082901916d30284acd2e19 (MD5) / Made available in DSpace on 2017-09-28T14:52:43Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertação roberto barcellos.pdf: 945783 bytes, checksum: 7e1ee727b4082901916d30284acd2e19 (MD5) Previous issue date: 2014 / Universidade Federal Fluminense / Introdução: Na população norte-americana, os níveis séricos de creatinina em negros são habitualmente maiores do que na população branca, pois estes possuem reconhecidamente maior massa muscular. Esta diferença justificou a partir do ano de 2006, o emprego nos Estados Unidos da América de um ajuste pela raça quando se utiliza as fórmulas para a estimativa das taxas de filtração glomerular (TFG). Questionamos se este ajuste pode ser empregado na população brasileira cuja origem e miscigenação são bastante diferentes da população norte-americana, sem a criação de um viés. Objetivo: O objetivo principal do presente estudo foi de avaliar e comparar os níveis séricos de creatinina em brancos, pardos e negros em uma amostra da população brasileira discutindo a necessidade do uso ajuste pela raça nas fórmulas que empregam a creatinina nesta população. Material e métodos: Os resultados foram extraídos de um estudo de população oriundo do Programa Médico de Família de Niterói (PMF), RJ. A análise da creatinina foi feita pelo método de Jaffé. Compararam-se os níveis séricos de creatinina entre brancos, pardos e negros classificados segundo critérios do IBGE. Posteriormente, foram estimadas as TFGs empregando-se a fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) com e sem ajuste pela raça. Resultados: Um total de 712 participantes (54,7% do sexo feminino) tiveram seus níveis séricos de creatinina analisados. A média de idade da população foi de 43 ± 12 anos. Trinta por cento eram brancos, 43 % pardos e 27% negros. A média da creatinina nos homens foi maior que a das mulheres (0,99 ± 0,23 mg/dl vs. 0,77 ± 0,17 mg/dl, p<0.001). Entretanto, não foram identificadas diferenças significativas nos níveis séricos de creatinina entre brancos (0,86 ± 22 mg/dl), pardos (0,87 ± 22 mg/dl) e negros (0,88 ± 25 mg/dl). Os níveis séricos de creatinina em mulheres brancas, pardas e negras foram respectivamente 0,76 ± 0,15 mg/dl, 0,77 ± 0,17 mg/dl e 0,79 ± 0,17 mg/dl. Os valores correspondentes para homens foram respectivamente 1,00 ± 0,23 mg/dl, 0,98 ± 0,19 mg/dl e 1,01 ± 0,30 mg/dl. Ao se utilizar a fórmula da CKD-EPI sem ajuste pela raça, não houve diferença significativa entre brancos, pardos e negros. Entretanto, se o ajuste pela raça tivesse sido aplicado, os valores da TFG teriam sido significativamente maiores (p< 0,001) resultando em um erro. Conclusão: Não houve diferença significativa nos níveis de creatinina sérica entre brancos, pardos e negros na população estudada. O emprego do ajuste pelo fator raça na população brasileira poderia trazer um viés no cálculo da TFG, superestimando os valores para pardos e negros / Background: Serum creatinine levels are usually higher among black people in the United States due to increased muscle mass justifying the addition of race adjustment in creatinine-based equations to estimate glomerular filtration rate (GFR). We speculate if this adjustment would create a bias when used in the Brazilian population whose origin and racial admixture is quite different from the American people. Objective: The aim of the present study was to assess if serum creatinine levels are different between white, brown (mixed-race background) and black people in a Brazilian population. Methods: Data were extracted from a community-based health program in Brazil. We compared serum creatinine levels in self-defined white, black and brown adults. Additionally, we also estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, with and without race adjustment. Results: A total of 712 participants (54.7% females, 43 ± 12 years old) were enrolled. Thirty percent of the subjects were white, 43% brown and 27% black. As expected, males had serum creatinine higher than females (0.99 ± 0.23 mg/dl vs. 0.77 ± 0.17 mg/dl, p<0.001). However, no significant differences were found between whites (0,86 ± 22 mg/dl), brown (0,87 ± 22 mg/dl) and blacks (0,88 ± 25 mg/dl). Serum creatinine levels for white, brown and black females were 0.76 ± 0.15 mg/dl, 0.77 ± 0.17 mg/dl and 0.79 ± 0.17 mg/dl, respectively. Correspondent values for males were 1.00 ± 0.23 mg/dl, 0.98 ± 0.19 mg/dl and 1.01 ± 0.30 mg/dl, respectively. When using the CKD-EPI equation without race adjustment, the eGFR was not different between white, brown and black subjects. However, if race-adjustment were adopted, estimated GFR values for Blacks would be significantly higher than for Whites (p<0.001). Conclusion: No significant differences in serum creatinine levels were found between white, brown and black people in this sample of a Brazilian population. It raises the question if the race-adjustment in creatinine-based equations for GFR estimation in our population would be appropriated

<p>Biochemical and epidemiological aspects of pre-eclampsia were investigated, with the main focus on possible pathophysiological differences between early-onset and late-onset disease.</p><p>In pre-eclamptic women poor correlation was found between albumin-creatinine ratio (ACR) in a random urine sample and total amount of albumin in a 24-hour urine collection. <i>(Paper I)</i><b> </b></p><p>In a cohort of women giving birth in Sweden in 1973-82 we estimated the adjusted incidence rate ratio (IRR) for ischaemic heart disease (IHD) during the years 1987–2001. The adjusted IRR for development of IHD was 1.6-2.8 in woman exposed to gestational hypertensive disease during her pregnancy compared with unexposed women. The higher risk represents more severe or recurrent hypertensive disease. <i>(Paper II)</i></p><p>Before delivery, in early-onset pre-eclampsia (24-32 weeks) there were pronounced alterations in plasma concentrations of soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), and also a higher placental 8-iso-PGF_2α concentration and an elevated serum ratio of plasminogen-activator inhibitor (PAI)-1 to PAI-2 compared with early controls. In late-onset pre-eclampsia (35-42 weeks) there were only moderate alterations in sFlt1 and PlGF concentrations, and the placental 8-iso-PGF_2α concentration and PAI-1/ PAI-2 ratio were similar to those in late controls. <i>(Papers III, V)</i> There was a rapid postpartum decrease in sFlt1 concentration in all groups. One week postpartum the sFlt1 concentration was persistently higher, however, in women with early-onset pre-eclampsia compared with early controls. <i>(Paper IV)</i></p><p>In conclusion: random ACR cannot replace 24-hour urine collections for quantification of albuminuria in pre-eclamptic women; gestational hypertensive disease, especially severe or recurrent, increases the risk for later IHD; early-onset, but not late-onset pre-eclampsia is associated with pronounced alterations of angiogenesis-related markers and only early-onset pre-eclampsia is associated with placental oxidative stress and an increased PAI-1/ PAI-2 ratio, all suggesting a stronger link between early-onset than late-onset pre-eclampsia and a dysfunctional placenta.</p>

Biochemical and epidemiological aspects of pre-eclampsia were investigated, with the main focus on possible pathophysiological differences between early-onset and late-onset disease. In pre-eclamptic women poor correlation was found between albumin-creatinine ratio (ACR) in a random urine sample and total amount of albumin in a 24-hour urine collection. (Paper I)<b> </b> In a cohort of women giving birth in Sweden in 1973-82 we estimated the adjusted incidence rate ratio (IRR) for ischaemic heart disease (IHD) during the years 1987–2001. The adjusted IRR for development of IHD was 1.6-2.8 in woman exposed to gestational hypertensive disease during her pregnancy compared with unexposed women. The higher risk represents more severe or recurrent hypertensive disease. (Paper II) Before delivery, in early-onset pre-eclampsia (24-32 weeks) there were pronounced alterations in plasma concentrations of soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), and also a higher placental 8-iso-PGF2α concentration and an elevated serum ratio of plasminogen-activator inhibitor (PAI)-1 to PAI-2 compared with early controls. In late-onset pre-eclampsia (35-42 weeks) there were only moderate alterations in sFlt1 and PlGF concentrations, and the placental 8-iso-PGF2α concentration and PAI-1/ PAI-2 ratio were similar to those in late controls. (Papers III, V) There was a rapid postpartum decrease in sFlt1 concentration in all groups. One week postpartum the sFlt1 concentration was persistently higher, however, in women with early-onset pre-eclampsia compared with early controls. (Paper IV) In conclusion: random ACR cannot replace 24-hour urine collections for quantification of albuminuria in pre-eclamptic women; gestational hypertensive disease, especially severe or recurrent, increases the risk for later IHD; early-onset, but not late-onset pre-eclampsia is associated with pronounced alterations of angiogenesis-related markers and only early-onset pre-eclampsia is associated with placental oxidative stress and an increased PAI-1/ PAI-2 ratio, all suggesting a stronger link between early-onset than late-onset pre-eclampsia and a dysfunctional placenta.

No description available.