2569例体检成年人单次尿液和肾功能检查结果分析

目的分析2569例体检成年人单次尿液和肾功能检查结果。方法选取2014年9月—2016年9月在北京市丰台区铁营医院进行体检的成年人2569例,分析其单次尿液和肾功能检查结果。结果共204例体检者单次尿液检查结果异常(占7.94%),其中男131例,女73例;单纯蛋白尿55例(占2.14%),单纯血尿61例(占2.37%),蛋白尿伴血尿24例(占0.94%),白细胞尿64例(占2.49%)。参照肾脏早期评估项目(KEEP)标准检出肾功能减退6例(占0.23%),其中男4例,女2例;参照美国全国健康与营养调查Ⅲ(NHANES Ⅲ)标准检出肾功能减退8例(占0.31%),其中男7例,女1例。结论临床需重视体检成年人单次尿液和肾功能检查结果,以期早期发现慢性肾脏病(CKD)。     

2569例体检成年人单次尿液和肾功能检查结果分析

目的分析2569例体检成年人单次尿液和肾功能检查结果。方法选取2014年9月—2016年9月在北京市丰台区铁营医院进行体检的成年人2569例,分析其单次尿液和肾功能检查结果。结果共204例体检者单次尿液检查结果异常(占7.94%),其中男131例,女73例;单纯蛋白尿55例(占2.14%),单纯血尿61例(占2.37%),蛋白尿伴血尿24例(占0.94%),白细胞尿64例(占2.49%)。参照肾脏早期评估项目(KEEP)标准检出肾功能减退6例(占0.23%),其中男4例,女2例;参照美国全国健康与营养调查Ⅲ(NHANES Ⅲ)标准检出肾功能减退8例(占0.31%),其中男7例,女1例。结论临床需重视体检成年人单次尿液和肾功能检查结果,以期早期发现慢性肾脏病(CKD)。     

20665例普通人群单次尿液和肾功能检查结果及其意义探讨

目的:了解普通人群健康体检时尿检异常(蛋白尿、血尿、白细胞尿)和肾功能减退的检出率,探讨其临床意义。方法:筛查2008-08-12复旦大学附属中山医院健康体检人群的尿液和肾功能检查资料。肾功能减退标准为血清肌酐mg/dl(μmol/L):(1)KEEP标准男性1.5(133),女性1.3(115);(2)NHANES Ⅲ标准男性1.4(124),女性1.2(106),老年(≥65岁)男性≥1.3(115),女性≥1.0(88.4)。结果:共20 665例,其中男性13 320例(64.46%),女性7 345例(35.54%)。尿检异常检出率5.27%,其中男性3.64%,女性8.22%(P0.01);蛋白尿2.68%,男性2.72%,女性2.60%,P0.01;血尿2.41%,男性1.47%,女性4.11%,P0.01;白细胞尿1.71%,男性0.46%,女性4.00%,P0.01。按照KEEP和NHANES Ⅲ标准,肾功能减退检出率分别为0.26%和0.76%,男性和女性分别为0.20%和0.38%(P0.05),0.35%和0.98%(P0.01)。尿检异常人群肾功能减退的检出率显著高于尿检正常人群(KEEP标准1.3%和0.2%,P0.01;NHANES Ⅲ标准2.0%和0.5%,P0.01);肾功能减退人群尿检异常的检出率显著高于肾功能正常人群(KEEP标准25.9%和5.2%,P0.01;NHANES Ⅲ标准18.6%和5.2%,P0.01)。结论:普通人群尿检异常和肾功能减退检出率较高。在健康体检中应重视尿液和肾功能检查,以提高肾脏病的检出率。     

肾小球滤过率对急慢性肾脏病患者溶质及电解质肾脏排泄分数的影响

目的:探索慢性肾脏病(CKD)中溶质及电解质肾脏排泄分数(FEx)和肾功能的关系，比较CKD和急性肾损伤(AKI)患者FEx的差别。方法:选取2020年1月至2022年8月在国家肾脏疾病临床医学研究中心诊治的具有完整血尿生化结果的CKD或AKI患者，分析估算的肾小球滤过率(e GFR)和FEx的关系，倾向得分匹配后比较CKD和AKI中FEx的差异。结果:研究纳入261例CKD和53例AKI患者。多数FEx随CKD进展进行性升高;钠、钾、氯、磷和尿酸的排泄分数(FENa、FEK、FECl、FEP和FEUA)与e GFR密切相关，并且建立了相对排泄分数(RFE)与e GFR的回归方程。AKI患者在e GFR-FEx散点图中与CKD患者表现出大致相同的趋势。倾向得分匹配后发现e GFR≥60 m L/(min·1.73m²)和<60 m L/(min·1.73m²)时，CKD和AKI之间有显著差异的分别为尿素排泄分数(FEUN)和FEUA。FEUN<12.95%[曲线下面积(AUC) 0.65，灵敏度70.0%，特异度57.1%]和FE...     

社区健康体检人群慢性肾脏病流行病学调查

目的 分析在遵医附院行健康体检的成人慢性肾脏病(CKD)的流行病学特点.方法 随机抽取2010年10月至2011年10月该院健康体检人群2 200例,进行问卷、体格检查及实验室检查,结果异常者3个月后复查,分析CKD、蛋白尿、血尿和eGFR相关危险因素.结果 在2 096例资料完整的体检人群中,蛋白尿检出率2.8％,血尿检出率7.7％,女性高于男性(P＜0.05),与年龄正相关;血肌酐升高检出率4.7％,eGFR ＜60 ml·min-1·1.73 m-2检出率为2.3％,随年龄增长肾功能呈下降趋势;肾脏B超影像学异常检出率16.2％.总体检人群中CKD患病率为27.4％,性别间无差异(P＞0.05),但随年龄增长CKD患病率升高,若剔除肾脏B超影像学异常,总CKD患病率14.9％.系统性疾病人群并发CKD明显高于一般人群,年龄、性别、高脂血症、高空腹血糖、高尿酸血症及肾结石、肾囊肿是CKD的危险因素.结论 健康体检有助于发现早期CKD,CKD诊断指标有待统一.     

中国成人及老年人群慢性肾脏病患病率Meta分析

目的获取中国成人及老年人慢性肾脏病(CKD)患病率。方法检索Pub Med、Sino Med、CNKI、维普、万方2007~2017年有关中国成人CKD流行病学调查研究对性别、老年、蛋白尿、血尿、肾小球滤过率(e GFR)下降(<60 ml/min)及地理分区进行亚组分析,并与中国大型横断面研究比较。结果最终纳入文献28篇,总调查161 084例,Egger回归显示不存在发表偏倚(P>0.05)。中国成人CKD未标化患病率为13.39%,女性患病率为14.41%,男性10.17%,60岁及以上老年人群患病率19.25%,60岁以下人群8.71%;蛋白尿、血尿及e GFR下降未标化患病率分别为7.30%、5.79%和2.59%;与中国大型横断面研究结果一致。西南地区CKD患病率最高为15.08%,华南地区最低(10.33%)。结论中国成人CKD患病率较高,老年人群尤为显著,单组率Meta分析结果可靠,加强CKD早期诊断及有效干预十分必要。     

我国汉族糖尿病慢性肾脏疾病与肌肽二肽酶1基因的相关性研究

目的探讨肌肽二肽酶1(CNDP1)基因多态性与中国汉族人群糖尿病慢性肾脏疾病(CKD)的关系。方法选取健康对照者(NC)90名、T2DM患者210例和CKD患者280例(CKD组再分为GFR≥90 ml/(min·1.73 m~2)亚组105例,60 ml/(min·1.73 m~2)≤GFR90 ml/(min·1.73 m~2)亚组84例,GFR60 ml/(min·1.73 m~2)亚组91例),利用聚合酶链反应限制性片段长度多态性分析法(PCR-RFLP)行CNDP1 rs4892247位点多态性检测。结果 NC、T2DM和CKD组TT、CT、CC 3种基因型频率分别为66.7%、26.7%、6.7%,60.5%、31.9%、7.6%和46.8%、43.2%、10.0%;C等位基因频率分别为20.0%、23.6%、31.6%;NC组与CKD组,T2DM组与CKD组基因型和等位基因C的频率分布差异有统计学意义(P0.05)。Logistic回归分析显示,携带C等位基因的CNDP1与CKD的发生呈正相关(OR=2.634,P0.05)。结论 CNDP1 rs4892247基因多态性可能与中国汉族人群发生CKD发病风险增高相关。     

Hcy与Cys-C联合检测对老年高血压患者早期肾损伤的诊断价值

目的 分析同型半胱氨酸(Hcy)与胱抑素(Cys)-C联合检测对老年高血压患者早期肾损伤的诊断价值。方法 回顾性分析老年高血压患者624例的临床资料，按照估算的肾小球滤过率(eGFR)分为肾功能正常组[eGFR≥90 ml/(min·1.73 m²)]355例，肾功能异常组[eGFR<90 ml/(min·1.73 m²)]269例，另选择健康志愿者(对照组)200例，3组均接受Hcy与Cys-C水平测量，并对检测结果进行分析，采用受试者工作特征(ROC)曲线分析血清指标诊断老年高血压患者早期肾损伤的价值，采用Spearman相关性分析Hcy与Cys-C的相关性。结果 肾功能正常组、肾功能异常组收缩压、舒张压明显高于对照组，肾功能正常组、对照组eGFR水平明显高于肾功能异常组(P<0.05)。肾功能正常组、肾功能异常组Hcy及Cys-C水平明显高于对照组，肾功能异常组明显高于肾功能正常组(P<0.05)。按照ROC曲线下面积(AUC)判断Hcy及Cys-C对老年高血压早期肾损伤的诊断价值，分析可知Hcy及Cys-C对老年高血...     

老年心房颤动患者慢性肾功能受损对血栓栓塞事件的影响

目的探讨老年心房颤动(房颤)患者慢性肾功能受损对血栓栓塞事件的影响。方法选择无抗凝治疗的老年房颤患者265例,根据慢性肾脏疾病分级分为估算肾小球滤过率(eGFR)≥60ml/(min·1.73m2)152例、eGFR45⁵9ml/(min·1.73m2)69例、eGFR<45ml/(min·1.73m2)44例,通过eGFR和尿蛋白的评估,观察其随访期间是否出现血栓栓塞事件。结果房颤血栓栓塞的发生与eGFR下降(RR=4.183,95%CI:2.57159ml/(min·1.73m2)69例、eGFR<45ml/(min·1.73m2)44例,通过eGFR和尿蛋白的评估,观察其随访期间是否出现血栓栓塞事件。结果房颤血栓栓塞的发生与eGFR下降(RR=4.183,95%CI:2.571⁶.805,P<0.01)和尿蛋白(RR=3.692,95%CI:2.7316.805,P<0.01)和尿蛋白(RR=3.692,95%CI:2.731⁵.105,P<0.01)相关。多因素分析显示,尿蛋白使血栓栓塞的危险性增加46.2%(HR=1.462,95%CI:1.2155.105,P<0.01)相关。多因素分析显示,尿蛋白使血栓栓塞的危险性增加46.2%(HR=1.462,95%CI:1.215¹.904,P<0.01);将eGFR≥60ml/(min·1.73m2)作为参照,eGFR在451.904,P<0.01);将eGFR≥60ml/(min·1.73m2)作为参照,eGFR在45⁵9ml/(min·1.73m2)出现血栓栓塞事件增加17.2%(HR=1.172,95%CI:0.91559ml/(min·1.73m2)出现血栓栓塞事件增加17.2%(HR=1.172,95%CI:0.915¹.402,P<0.01),eGFR<45ml/(min·1.73m2)则增加42.1%(HR=1.421,95%CI:1.2111.402,P<0.01),eGFR<45ml/(min·1.73m2)则增加42.1%(HR=1.421,95%CI:1.211¹.816,P<0.01)。结论慢性肾功能受损增加了不用抗凝药物的老年房颤患者血栓栓塞的危险性。     

老年2型糖尿病肾病患者血清Metrnl与肾功能及微炎性反应的相关性

目的 探讨老年2型糖尿病(T2DM)肾病患者血清Metrnl与肾功能及微炎性反应之间的相关性。方法 选取老年T2DM患者146例,根据是否合并肾脏病变,分为单纯T2DM(T2DM)组(n=70),2型糖尿病肾脏疾病(DKD)组(n=76),再将DKD组根据肾小球滤过率(eGFR)分3个亚组：轻度DKD组[eGFR≥60 ml/(min·1.73 m²),n=28],中度DKD组[30 ml/(min·1.73 m²)≤eGFR<60 ml/(min·1.73 m²),n=26],重度DKD组[eGFR<30 ml/(min·1.73 m²),n=22]。选取同期健康体检者为对照组(n=55)。所有受试者记录腰围、臀围,计算腰臀比(WHR),测量血压。测定血清Metrnl、空腹血糖(FPG),肾功能指标[肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、胱抑素(Cys)-C、β2微球蛋白(MG)]、血脂、空腹胰岛素(FIns)、糖化血红蛋白(HbA1c)及微炎性指标[超敏C反应蛋白(hs-C...     

Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study.

The prevalence of stage 3 to 5 chronic kidney disease (CKD) in Japan (18.7%) is considerably higher than that in the United States (4.5%). This study investigated in the Japanese general population whether this higher prevalence of CKD might reflect to a progressive decline of renal function, and in turn to the increased risk of end-stage renal disease. A decline in renal function over 10 years was examined in 120,727 individuals aged 40 years or older who participated in the annual health examination program of the two periods over 10 years, 1988-1993 and 1998-2003. Renal function was assessed with estimated glomerular filtration rate (GFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) Study equation modified by a Japanese coefficient. The rate of GFR decline in the participants was 0.36 mL/min/1.73 m2/year on average. In the male population aged 50-79, the mean rate of GFR decline was significantly higher in the presence of hypertension than in its absence. The rate of GFR decline was more than two times higher in participants with proteinuria than in those without proteinuria in both sexes. The rate was significantly higher in participants with an initial GFR<50 mL/min/1.73 m2 among the groups younger than age 70 and in participants with an initial GFR<40 mL/min/1.73 m2 in the group with age 70-79. Based on the slow rate of GFR decline, we concluded that the decline in renal function progresses slowly in the Japanese general population. Hypertension, proteinuria and lower GFR were found to be significant risk factors for a faster decline of GFR.     

血压评估参数与老年男性慢性肾脏病合并高血压病人肾功能下降的关系

目的研究不同血压评估参数与老年男性慢性肾脏病(CKD)3~4期合并高血压病人肾功能下降的关系。方法对2015年1月至2019年12月北京同仁医院老年医学科/干部医疗科112例CKD 3~4期合并高血压的老年男性病人的临床资料进行回顾性分析,记录病人连续2年临床检验数据及此2年间动态血压监测数据。以2年间eGFR减低>8 mL/(min·1.73m²)为肾功能进展依据,将病人分为肾功能稳定组和肾功能下降组,分析2组病人血压评估参数的差异。结果2年前肾功能稳定组肾功能基线水平低于肾功能下降组(P<0.05),其余临床资料2组间差异无统计学意义(P>0.05);2组病人2年后肾功能及其他指标比较,差异均无统计学意义(P>0.05)。与肾功能稳定组相比,肾功能下降组2年前及2年后血压控制情况都较差,其白昼SBP平均值较高,白昼SBP不达标值占比亦较高。结论血压变异增大在老年男性CKD 3~4期病人中普遍存在,SBP控制不良可能是推动肾功能下降的主要原因之一。     

富马酸替诺福韦二吡呋酯对HBV感染孕妇肾功能和胎儿生长发育的安全性研究*

目的 评估HBV感染孕期应用富马酸替诺福韦二吡呋酯(TDF)抗病毒治疗对肾功能及对胎儿生长发育的影响。方法 2018年7月1 日～2019年6月30日首都医科大学附属北京佑安医院分娩的HBV感染孕妇120例,孕期全程口服TDF治疗40例(A组),孕中晚期口服TDF治疗40例(B组),未抗病毒治疗40例(C组)。检测血清磷(P)、肾小球滤过率(GFR)、肌酐(sCr)、肌酸激酶(CK)、尿蛋白(uPRO),记录新生儿出生时头围、身长、体质量和不良事件。结果 在孕36周时,A组血P、GFR、sCr、CK和uPRO分别为(1.2±0.1)mmol/L、(120.9±7.9)mL/(min·1.73 m²)、(52.1±7.9)μmol/L、(57.7±21.8)U/L、6例(15.0%),与B组【分别为(1.2±0.1)mmol/L、(119.5±9.4)mL/(min·1.73 m²)、(50.6±7.7)μmol/L、(56.6±18.8)U/L、5例(12.5%)】或C组【分别为(1.2±0.1)mmol/L、(125.7±8.7)mL/(min·1.73 m²)、(48.9±7.2)μmol/L、(53.9±16.1)U/L、4例(10.0%)】比,均无显著性差异(P>0.05);分娩时,A组孕妇新生儿身高、头围和体质量分别为(50.0±1.1)cm、(333.6±5.1)cm和(3383±319)g,与B组【分别为(49.9±1.2)cm、(333.9±5.1)cm和(3215±327)g】或C组【分别为(50.1±1.1)cm、(332.9±5.7)cm和(3284±328)g】比,均无显著性差异(P>0.05);在分娩不良事件方面,仅C组出现1例新生儿锁骨骨折。结论 TDF对HBV感染孕妇肾功能和胎儿生长发育无显著影响,母儿安全性良好。     

Comparison of bare-metal and drug-eluting stents in patients with chronic kidney disease (from the NHLBI Dynamic Registry)

Patients with chronic kidney disease (CKD) have a disproportionate burden of coronary artery disease and commonly undergo revascularization. The role and safety of percutaneous coronary intervention (PCI) using drug-eluting stents (DESs) verses bare-metal stents in patients with CKD not on renal replacement therapy has not been fully evaluated. This study investigated the efficacy and safety of DES in patients with CKD not on renal replacement therapy. Patients were drawn from the National Heart, Lung, and Blood Institute Dynamic Registry and were stratified by renal function based on estimated glomerular filtration rate (GFR). Of the 4,157 participants, 1,108 had CKD ("low GFR" <60 ml/min/1.73 m(2)), whereas 3,049 patients had normal renal function ("normal GFR" ≥60 ml/min/1.73 m(2)). For each stratum of renal function we compared risk of death, myocardial infarction, or repeat revascularization between subjects who received DESs and bare-metal stents at the index procedure. Patients with low GFR had higher 1-year rates of death and myocardial infarction and a decreased rate of repeat revascularization compared to patients with normal GFR. Use of DESs was associated with a decreased need for repeat revascularization in the normal-GFR group (adjusted hazard ratio 0.63, 95% confidence interval 0.50 to 0.79, p <0.001) but not in the low-GFR group (hazard ratio 0.69, 95% confidence interval 0.45 to 1.06, p = 0.09). Risks of death and myocardial infarction were not different between the 2 stents in either patient population. In conclusion, presence of CKD predicted poor outcomes after PCI with high rates of mortality regardless of stent type. The effect of DES in decreasing repeat revascularization appeared to be attenuated in these patients.     

尿白蛋白水平升高预测不合并糖尿病的射血分数降低的心力衰竭患者预后的价值

目的:分析入院时尿白蛋白水平(UAC)升高对不合并糖尿病的射血分数降低的心力衰竭(HFrEF)患者预后的评价价值.方法:入选2013年1月至2017年12月期间于北京水利医院内科住院的不合并糖尿病的HFrEF患者212例.留取患者入院后次日晨起首次中段尿检测UAC,以≥30 mg/L定义为UAC升高.出院后通过电话或门...     

Progression of Pediatric CKD of Nonglomerular Origin in the CKiD Cohort

Background and objectives

Congenital anomalies of the kidney and urinary tract and genetic disorders cause most cases of CKD in children. This study evaluated the relationships between baseline proteinuria and BP and longitudinal changes in GFR in children with these nonglomerular causes of CKD.

Design, setting, participants, & measurements

Urine protein-to-creatinine ratio, casual systolic and diastolic BP (normalized for age, sex, and height), and GFR decline were assessed in the prospective CKD in Children cohort study.

Results

A total of 522 children, median age 10 years (interquartile range, 7, 14 years) with nonglomerular CKD were followed for a median of 4.4 years. The mean baseline GFR in the cohort was 52 ml/min per 1.73 m² (95% confidence interval [95% CI], 50 to 54) and declined 1.3 ml/min per 1.73 m² per year on average (95%CI, 1.6 to 1.1). A 2-fold higher baseline urine protein-to-creatinine ratio was associated with an accelerated GFR decline of 0.3 ml/min per 1.73 m² per year (95% CI, 0.4 to 0.1). A 1-unit higher baseline systolic BP z-score was associated with an additional GFR decline of 0.4 ml/min per 1.73 m² per year (95% CI, 0.7 to 0.1). Among normotensive children, larger GFR declines were associated with larger baseline urine protein-to-creatinine ratios; eGFR declines of 0.8 and 1.8 ml/min per 1.73 m² per year were associated with urine protein-to-creatinine ratio <0.5 and ≥0.5 mg/mg, respectively. Among children with elevated BP, average GFR declines were evident but were not larger in children with higher levels of proteinuria.

Conclusions

Baseline proteinuria and systolic BP levels are independently associated with CKD progression in children with nonglomerular CKD.     

老年人群慢性肾脏疾病流行病学研究

目的 了解我国老年人群慢性肾脏疾病(CKD)的患病率及其影响因素.方法 对2004年1月至2007年1月长期在北京医院老年病房进行健康查体及疾病治疗、病历资料完整的老年人进行回顾性调查.分别记录受检者年龄、身高、体质量、血压、血尿、蛋白尿、血红蛋白、血肌酐、血尿素、血脂、血尿酸、乙肝表面抗原、影像学检查结果 以及既往诊断疾病情况,采用公式法估算肾小球滤过率,并对影响蛋白尿及CKD的危险因素进行二分类Logistic回归分析.结果 1082例老年人中,蛋白尿检出率为4.9%,肾功能下降为47.2%,CKD检出率为48.4%;多因素Logistic回归分析表明,糖尿病(OR=2.257)和镜下血尿(OR=5.324)是老年人发生蛋白尿的危险因素(P<0.05),高血压(OR=1.459)、冠心病(OR=3.290)、慢性阻塞性肺病(OR=2.094)、恶性肿瘤(OR=2.072)、高尿酸血症(OR=1.928)、贫血(OR=8.122)、血尿(OR=1.604)是发生CKD的危险因素(P<0.05).结论 初步估计我国特殊老年人群的CKD患病率为48.4%,相关危险因素有糖尿病、高血压、高尿酸血症、贫血等,与发达国家水平相似.     

Natural history of older adults with impaired kidney function: the InCHIANTI study

The aim of this study was to assess the kidney function of an older community-dwelling population at baseline and appraise its evolution after 3 years of follow-up in terms of chronic kidney disease (CKD) stage progression, magnitude of glomerular filtration rate (GFR) changes, and value of serum creatinine. This was a prospective population-based study of 676 Italian participants, aged 65 years and older. GFR was estimated using the Cockcroft-Gault equation and the Modification of Diet in Renal Disease Study equation. Using the Cockcroft-Gault equation. A total of 33% of participants had criteria of CKD (GFR??90?mL/min) at baseline worsened to stage 2 and 10% worsened to stage 3. An abnormal high level of serum creatinine at baseline did not help to predict who might worsen at follow-up. Older people with CKD displayed a low progression of renal disease and therefore are at higher risk for co-morbidities related to CKD than for progression to end-stage renal disease.     

Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia

Background

Diabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine.

Methods

A total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine.

Results

CKD, defined as eGFR?<?60 ml/min/1.73 m², was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR <60 ml/min/1.73 m² had abnormal serum creatinine values, i.e. > 1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2–3 CKD) despite normal creatinine levels. CKD, eGFR?<?60 ml/min/1.73 m², was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively.

Conclusion

CKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2–3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

     

The midnight-to-morning urinary cortisol increment method is not reliable for the assessment of hypothalamic-pituitary-adrenal insufficiency in patients with end-stage kidney disease

A previous study reported that the midnight-to-morning urinary cortisol increment method could be used to reliably assess the insufficiency of the hypothalamic-pituitary-adrenal (HPA) axis. The principal aim of the present study is to verify whether the midnight-to-morning urinary cortisol increment is a reliable method for the assessment of the HPA axis in patients with various degrees of impaired kidney function. Fifty-six clinically stable patients with chronic kidney disease (CKD) and 14 healthy subjects were enrolled in the present study. Patients with CKD were divided on the basis of glomerular filtration rate (GFR) into the following arbitrary groups: mild (GFR: 60-89 ml/min/1.73 m2, no.=15), moderate (GFR: 30-59 ml/min/1.73 m2, no.=12) and severe kidney insufficiency (GFR: 15-29 ml/min/1.73 m2, no.=13), and hemodialysis patients. Plasma cortisol and ACTH levels were measured. The HPA axis was assessed by short Synacthen test and overnight dexamethasone suppression test. Double voided urine samples were collected at midnight and waking in the patients and the controls. Urinary free cortisol (UFC) and creatinine levels were measured and the UFC/creatinine ratio (Cort/Cr) was calculated. Then, the Cort/Cr increment was calculated as the morning Cort/Cr minus the midnight Cort/Cr. Baseline plasma cortisol levels were not significantly different between two groups. However, we found that CKD patients had significantly greater plasma ACTH levels than controls. The patients with CKD had also significantly lower morning UFC levels than controls and there was a progressive fall in morning UFC levels with decreasing GFR. The assessment of the HPA axis in patients with GFR lower than 29 ml/min was hampered by falsely abnormal responses to the midnight-to-morning urinary cortisol increment method. Plasma cortisol responded normally to exogenously administered ACTH, while plasma cortisol was suppressed by overnight dexamethasone administration in all patients with CKD. In conclusion, this method is not a reliable test for assessment of the HPA insufficiency in patients with GFR lower than 29 ml/min.