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1.
Elisa A. Ylinen Marja Ala-Houhala A. P. T. Harmoinen Mikael Knip 《Pediatric nephrology (Berlin, Germany)》1999,13(6):506-509
Cystatin C is a non-glycated 13-kilodalton basic protein produced by all nucleated cells. The low molecular mass and the basic
nature of cystatin C, in combination with its stable production rate, suggest that the glomerular filtration rate (GFR) is
the major determinant of cystatin C concentration in the peripheral circulation. Recently published studies have shown that
cystatin C correlates more strongly than creatinine with GFR measured using the 51Cr-EDTA clearance. The aim of this study was to evaluate serum cystatin C as a marker for GFR in children. GFR was determined
on medical indications using the 51Cr-EDTA technique in pediatric patients (2–16 years) in our renal unit. Simultaneously their cystatin C and creatinine concentrations
were also measured. Of our 52 patients, 19 had a reduced renal function (<GFR 89 ml/min per 1.73 m2) based on the 51Cr-EDTA clearance. The correlation of cystatin C with the isotopic measurement of GFR tended to be stronger (r=0.89, P=0.073) than that of creatinine (r=0.80). Receiver operating characteristic analysis showed that the diagnostic accuracy of cystatin C was better (P=0.037) than that of creatinine in discriminating between subjects with normal renal function and those with reduced GFR.
This study demonstrates that serum cystatin C has an increased diagnostic accuracy for reduced GFR when compared with serum
creatinine. Hence, cystatin C seems to be an attractive alternative for the estimation of GFR in children.
Received: 13 May 1998 / Revised: 22 September 1998 / Accepted: 22 October 1998 相似文献
2.
Alvarez O Zilleruelo G Wright D Montane B Lopez-Mitnik G 《Pediatric nephrology (Berlin, Germany)》2006,21(4):533-537
Patients with sickle cell disease (SCD) may develop kidney dysfunction from childhood. The purpose of this study was to examine
the value of serum cystatin C as a marker for glomerular filtration rate (GFR) in children with SCD, as compared to serum
creatinine and creatinine clearance (CrCl). Twenty children (ages 9–21, ten males) with SCD with and without albuminuria were
studied. The mean serum cystatin for the whole group was 0.89 mg/l (0.5–1.7 mg/l). Mean serum cystatin C was significantly
different among the children with proteinuria (n=4), microalbuminuria (n=5), and without albuminuria (n=11) (1.25 mg/l, 0.84 mg/l, and 0.78 mg/l, respectively). The mean GFR derived from serum cystatin was significantly different
among these subgroups, becoming abnormal in the proteinuric cohort (63 ml/min per 1.73 m2), in contrast to 94 for the microalbuminuric, and 103 for the normal subgroups. Serum creatinine (mean: 0.58 mg/dl, range:
0.3–1.1) did not change significantly with the level of albuminuria. Mean CrCl remained normal to increased within the subgroups,
(133 ml/min per 1.73 m2 for those with proteinuria, 144 for those with microalbuminuria, and 163 for the normal subgroup). We conclude that serum
cystatin C correlates with the level of albuminuria and may be a reliable method to measure renal function in SCD.
An erratum to this article can be found at 相似文献
3.
Serum neutrophil gelatinase-associated lipocalin as a marker of renal function in children with chronic kidney disease 总被引:4,自引:4,他引:0
Mitsnefes MM Kathman TS Mishra J Kartal J Khoury PR Nickolas TL Barasch J Devarajan P 《Pediatric nephrology (Berlin, Germany)》2007,22(1):101-108
Very few biomarkers exist for monitoring chronic kidney disease (CKD). We have recently shown that serum neutrophil gelatinase-associated
lipocalin (NGAL) represents a novel biomarker for early identification of acute kidney injury. In this study, we hypothesized
that serum NGAL may also represent a biomarker for the quantitation of CKD. Forty-five children with CKD stages 2–4 were prospectively
recruited for measurement of serum NGAL, serum cystatin C, glomerular filtration rate (GFR) by Ioversol clearance, and estimated
GFR (eGFR) by Schwartz formula. Serum NGAL significantly correlated with cystatin C (r=0.74, P<0.000). Both NGAL and cystatin C significantly correlated with measured GFR (r=0.62, P<0.000; and r=0.71, P<0.000, respectively) as well as with eGFR (r=0.66, P<0.000 and r=0.59, P<0.000, respectively). At GFR levels of ≥30 ml/min per 1.73 m2, serum NGAL, cystatin C, and eGFR were all significantly correlated with measured GFR. However, in subjects with lower GFRs
(<30 ml/min per 1.73 m2), serum NGAL levels correlated best with measured GFR (r=0.62), followed by cystatin C (r=0.41). We conclude that (a) both serum NGAL and cystatin C may prove useful in the quantitation of CKD, and (b) by correlation
analysis, NGAL outperforms cystatin C and eGFR at lower levels of measured GFR. 相似文献
4.
Kranz B Vester U Büscher R Wingen AM Hoyer PF 《Pediatric nephrology (Berlin, Germany)》2008,23(4):581-586
The impact of cyclosporine A (CsA) therapy in patients with steroid-dependent nephrotic-syndrome (SDNS) on long-term renal
function is controversial. Data beyond 5 years are rare. Long-term renal function was evaluated in children with SDNS with
and without CsA therapy, especially beyond 5 years. Twenty children were treated with CsA (study group) for a mean of 5.4 ± 2.2 years
(ten patients for 5–11 years). Glomerular filtration rate (GFR) was calculated before and after 3 and 12 months and at latest
follow-up of therapy. Fifteen children with cyclophosphamide-treated SDNS without CsA served as controls. In the study group,
GFR decreased within 12 months from 136 ± 19 to 120 ± 31, to 114 ± 14 ml/min per 1.73 m2 at latest follow-up (p < 0.0001). Patients with CsA > 5 years had a GFR of 111 ± 14 ml/min per 1.73 m2 at latest follow-up without a GFR below 90 ml/min per 1.73 m2. No CsA toxicity was found in biopsies. In the control group, GFR dropped within 3 months, from 137 ± 27 to 130 ± 24, to
126 ± 19 ml/min per 1.73 m2 at latest follow-up (p = 0.1). Patients with and without nephrotoxic CsA therapy showed a drop in GFR. In CsA-treated patients, GFR was about 12%
lower at latest follow-up compared with patients without nephrotoxic therapy but always remained within normal range. CsA
seems to be safe, even in long-term treatment for more than 5 years. 相似文献
5.
G. Filler F. Priem I. Vollmer J. Gellermann K. Jung 《Pediatric nephrology (Berlin, Germany)》1999,13(6):501-505
Recently, the reciprocal of cystatin C (Cys-C), a non-glycosylated 13-kilodalton protein that is produced by all investigated
nucleated cells, was found to correlate closely with glomerular filtration rate (GFR). In order to determine the diagnostic
validity in children for the detection of impaired GFR, venous blood samples from 381 children (aged 1.7–18 years) with various
renal pathology referred for 51Cr-EDTA clearance investigations were obtained for measurement of Cys-C as well as β2-microglobulin (β2-MG) and serum creatinine. Two hundred and sixteen children with clearance values >90 ml/min per 1.73 m2 constituted a control group, with a normal GFR. In the control group, Cys-C values were normally distributed with a mean
of 0.94±0.27 mg/l and an upper reference limit (97.5th percentile) of 1.47 mg/l. In all children, there was a positive correlation
between 51Cr-EDTA clearance and the reciprocal of Cys-C (r=0.64, P<0.0001), β2-MG (r=0.59, P<0.0001), creatinine (r=0.55, P<0.0001), and the height/creatinine ratio (r=0.73, P<0.0001). Receiver-operating characteristics analysis showed that there were no significant differences between these three
parameters for discriminating between patients with normal and reduced GFR, although there was a tendency towards the best
diagnostic sensitivity of the GFR estimate according to the Schwartz formula. We conclude that for the detection of mildly
impaired GFR, a full clearance study cannot be replaced by measurement of serum Cys-C or β2-MG concentrations.
Received: 15 June 1998 / Revised: 22 September 1998 / Accepted: 23 September 1998 相似文献
6.
This retrospective survey examines the etiology of nephrocalcinosis (NC) in 40 patients (26 boys), over an 8-year period.
The median age at onset of symptoms and presentation was 36 months and 72 months, respectively. Clinical features included
marked failure to thrive (82.5%), polyuria (60%) and bony deformities (52.5%). The etiology of NC included distal renal tubular
acidosis (RTA) in 50% patients and idiopathic hypercalciuria and hyperoxaluria in 7.5% each. Other causes were Bartter syndrome,
primary hypomagnesemia with hypercalciuria, severe hypothyroidism and vitamin D excess. No cause for NC was found in 12.5%
patients. Specific therapy, where possible, ameliorated the biochemical aberrations, although the extent of NC remained unchanged.
At a median (range) follow up of 35 (14–240) months, glomerular filtration rate (GFR) had declined from 82.0 (42–114) ml/min
per 1.73 m2 body surface area to 70.8 (21.3–126.5) ml/min per 1.73 m2 body surface area (P = 0.001). Our findings confirm that, even with limited diagnostic facilities, protocol-based evaluation permits determination
of the etiology of NC in most patients. 相似文献
7.
Grönroos MH Jahnukainen T Irjala K Härkönen R Hurme S Möttönen M Salmi TT 《Pediatric nephrology (Berlin, Germany)》2008,23(5):797-803
Evaluation of renal function should be performed as part of the follow-up during and after chemotherapy in pediatric cancer
patients. The aim of this study was to compare an isotope clearance method [isotope glomerular filtration rate (iGFR)] with
alternative methods to determine GFR in such patients. Isotope GFR [99mTc-labeled diethylene triaminopentoacetic acid (DTPA) or 51Cr-labeled ethylenediaminetetra-acetate (EDTA)] was measured in 36 children (112 studies) and compared with simultaneously
measured creatinine clearance (CrCl), serum creatinine (SCr), and cystatin C (CysC) concentrations, as well as the results
of Schwartz, Counahan–Barratt, and Cockroft–Gault formulae, using general linear mixed models. Our results showed a significant
association between iGFR and CysC concentrations (p < 0.001). No linear relationship was observed between CrCl and iGFR (p = 0.7). As expected, the results of height-based formulae (Counahan–Barratt and Schwartz) had significantly (p = 0.004) better correlation to iGFR than the results of a formula based on weight (Cockroft–Gault) (p = 0.19). Despite significant linear correlation, intraclass correlation coefficients showed poor agreement. Tests of similarity
between iGFR estimates showed differences between average values of GFR. Therefore, determination of iGFR remains the method
of choice in estimation of GFR in cancer patients. In our study population, assay of serum CysC was the most reliable alternative
method to measure glomerular function. 相似文献
8.
Correlation between cystatin C- and renal scan-determined glomerular filtration rate in children with spina bifida 总被引:1,自引:0,他引:1
Morgan C Senthilselvan A Bamforth F Hoskinson M Gowrishankar M 《Pediatric nephrology (Berlin, Germany)》2008,23(2):329-332
We report on the relationships between serum cystatin C level, glomerular filtration rate (GFR) estimated from a cystatin C-based
prediction equation (that of Filler and Lepage), GFR calculated by the Schwartz formula and technetium 99m-diethylene triamine
penta-acetic acid (99Tc-DTPA)-determined GFR in 28 children with spina bifida. All children underwent measurement of height, weight, serum cystatin C
level, and serum creatinine level at the time of their renal scan. The relationship between variables was assessed by Pearson
correlation. Pearson correlation for the relationship between 99Tc-DTPA GFR and GFR calculated by the cystatin C-based equation was significant and higher than that of the relationship between
99Tc-DTPA GFR and GFR calculated by the Schwartz equation, which was not statistically significant. The correlation for Filler
GFR was 0.42 (P = 0.03) and for Schwartz GFR was 0.21 (P = 0.28). Although we use renal scan determination of GFR as the best measure, and a creatinine-based formula as the most
practical measure, perhaps a formula such as that published by Filler and Lepage, which is not dependent on anthropometric
data, might be a more useful (and accurate) tool for establishing GFR in children with spina bifida. 相似文献
9.
Assadi M Eftekhari M Hozhabrosadati M Saghari M Ebrahimi A Nabipour I Abbasi MZ Moshtaghi D Abbaszadeh M Assadi S 《International urology and nephrology》2008,40(4):1059-1065
The gamma camera uptake method with Tc-99m-DTPA (diethylenetriaminepentaacetic acid) is a simple method for determination
of glomerular filtration rate (GFR), and is less time-consuming than other methods, but its diagnostic accuracy is debated.
Gate’s method (low-dose; LD), the high-dose method (HD), the predicted-clearance method, and the plasma-clearance method with
Tc-99m-DTPA are compared in this study. We also performed GFR measurement and diuretic renography simultaneously. Tc-99m DTPA
renography was performed in 36 patients aged 18–72 years with a wide range of renal function (serum creatinine 1.37 ± 0.49
mg/dl). GFR was determined by four methods: the gamma camera uptake method with low-dose Tc-99m DTPA (Gates, LD); the gamma
camera uptake method with high-dose Tc-99m DTPA (HD); the predicted creatinine clearance method (Cockcroft–Gualt, CG); and
the plasma sample clearance (PSC) method using a mono-exponential curve. The PSC method was chosen as reference. The regression
equations for the CG, Gates (low-dose), and HD methods against the PSC method were 28.68 + 0.80X (r = 0.72; P value < 0.0001, RMSE = 21.65 ml/min/1.73 m2), 6.19 + 0.79X (r = 0.90; P value < 0.0001, RMSE = 10.64 ml/min/1.73 m2), and 6.53 + 0.88X (r = 0.93; P value < 0.0001, RMSE = 9.35 ml/min/1.73 m2), respectively. In comparison with determination of GFR by the PSC method, the CG method tended to overestimate GFR while,
perversely, the LD and HD methods tended to underestimate GFR. The three methods were in agreement with the PSC method but
the high-dose GFR method resulted in less error in estimation of GFR. Furthermore, GFR measurement and diuretic renography
could be performed at the same time when the high-dose method was used. Because of the low cost and negligible radiation burden,
this method might be preferred for routine practice in nuclear medicine. 相似文献
10.
11.
Amira Peco-Antić Jelena Marinković Divna Kruščić Dusan Paripović 《Pediatric nephrology (Berlin, Germany)》2009,24(6):1165-1172
The aim of our study was to examine diurnal variation in urine volume (UV) output, proteinuria (UPRT), urine creatinine (UCr)
and urine sodium ion excretion (UNa) in children with chronic glomerulopathy. In 56 patients (20 boys/36 girls, aged 11.7 ± 0.6 years)
samples for UPRT, UCr and UNa were collected during the day and night, with continuous ambulatory blood pressure (BP) monitoring.
On the basis of creatinine clearance (CrCl) the patients were divided into group I (n = 44, with CrCl 131 ± 3.6 ml/min per 1.73 m2 body surface area), or group II (n = 12, with CrCl 44.6 ± 7.7 ml/min per 1.73 m2 body surface area). Nocturnal polyuria was defined as night time UV ≥ 35% of the 24 h UV. Age, gender, body mass index of
the patients, 24 h UV, UCr and UNa were similar in both groups. However, arterial hypertension and nocturnal polyuria were
widespread (P < 0.01) in group II. In addition, proteinuria was higher (P < 0. 05) in group II. The nocturnal decline in CrCl, UV, UPRT and UNa was significantly attenuated (P < 0.005) in patients in group II compared with those in group I. The night time mean arterial pressure (MAP), as well as
the night/day ratios of MAP, UV, UPRT and UNa, showed negative associations with CrCl. Our findings strongly suggest that
renal function diurnal variation and nocturnal MAP are related to decreased glomerular filtration rate at the time of examination. 相似文献
12.
Xiaohua Pei Qiao Liu Juan He Lihua Bao Chengjing Yan Jianqing Wu Weihong Zhao 《International urology and nephrology》2012,44(6):1877-1884
Purpose
Cystatin C has been proposed as a surrogate marker of kidney function. The elderly population accounts for the largest proportion of chronic kidney disease (CKD) patients. The aim of this study was to assess the diagnostic value of serum cystatin C and compare the applicability of cystatin C-based equations with serum creatinine (Scr)-based equations for estimating glomerular filtration rate (GFR).Methods
The estimated GFR (eGFR) values from six cystatin C-based equations (Tan, MacIsaac, Ma, Stevens1-3) and three Scr-based equations (CG, MDRD, CKD-EPI) were compared with the reference GFR (rGFR) values from 99mTc-DTPA renal dynamic imaging method.Results
A total of 110 elderly Chinese (60?C92?year, 71.05?±?7.62?year) were enrolled. Cystatin C had better diagnostic value than Scr (relationship coefficient with rGFR: cystatin C ?0.847 vs. Scr ?0.729, P?<?0.01; sensitivity: cystatin C 0.90 vs. Scr 0.55, P?<?0.01; AUCROC: cystatin C 0.857 vs. Scr 0.757, P?<?0.01). All the equations predicted GFR more accurately for rGFR????60?ml/min/1.73?m2 than for rGFR?<?60?ml/min/1.73?m2. Most equations had acceptable accuracy. The cystatin C-based equations deviated from rGFR by ?12.78?ml/min/1.73?m2 to ?2.12?ml/min/1.73?m2, with accuracy varying from 64.6 to 82.7?%. The Scr-based equations deviated from rGFR by ?5.37?ml/min/1.73?m2 to ?0.68?ml/min/1.73?m2, with accuracy varying from 77.3 to 79.1?%. The CKD-EPI, MacIsaac and Ma equations predicted no bias with rGFR (P?>?0.05), with higher accuracy and lower deviation in the total group. The MacIsaac, CKD-EPI and Stevens3 equations could be optimal for those with normal and mildly impaired kidney function, whereas the Ma equation for those with CKD.Conclusion
Cystatin C is a promising kidney function marker. However, not all cystatin C-based equations could be superior to the Scr-equations. 相似文献13.
In a cross-sectional study, we compared the prevalence of anemia based on age- and gender-specific reference intervals for
hemoglobin (Hgb) and hematocrit (Hct) with the Kidney Disease Outcomes Quality Initiative (KDOQI) anemia definition (Hgb < 110 g/L)
in 351 children with chronic kidney disease (CKD) stages I–V. Cystatin C-based GFRs were 122 ± 36 mL/min/1.73 m2 in patients with stage I CKD (n = 196), 76 ± 8 mL/min/1.73 m2 for stage II (n = 104), 45 ± 9 mL/min/1.73 m2 for stage III (n = 36), and 22 ± 5 mL/min/1.73 m2 in patients with stage IV+V CKD (n = 15). Fifty-nine patients received iron therapy and 32 patients were treated with Darbepoetin. For Hgb, a total of 90 patients
fit the age and gender derived criteria, compared to only 54 patients identified by the KDOQI guidelines (p = 0.0010). Similarly, for Hct, a total of 78 patients fit the age and gender derived criteria, which was a significantly
higher proportion than the 56 identified by the KDOQI guidelines (r = 0.22, p = 0.0435). There was a significant correlation between the GFR and both the Hgb Z-score (p = 0.0068) and the Hct Z-score (p = 0.0128). There was poor agreement between conventional and KDOQI definitions of anemia in children with CKD. 相似文献
14.
Bláhová K Janda J Kreisinger J Matejková E Sedivá A 《Pediatric nephrology (Berlin, Germany)》2002,17(6):400-403
Fifty-seven children (f/m=31/26) who survived diarrhea (D) + hemolytic uremic syndrome (HUS) were evaluated. The examinations
were performed 1–27 years (median 7 years) from the onset of the acute disease. Patients aged 2.3–27 years (median 10 years)
were allocated to three groups: Recovery (R, complete recovery), Residual renal symptoms (RRS, hematuria and/or proteinuria
and/or hypertension with glomerular filtration rate (GFR) >80 ml/min/1.73 m2, or moderate renal insufficiency with slightly decreased GFR to 60–80 ml/min/1.73 m2 with or without residual renal symptoms), and Chronic renal insufficiency/failure (CRI/F, dialysis, transplantation – GFR
<60 ml/min/ 1.73 m2). Results from 18 patients who survived more than 10 years after HUS demonstrated a high prevalence of renal damage. Only
6/18 patients were in group R, 7/18 patients were in group RRS and 5/18 patients were in group CRI/F. An early onset of HUS
(36 patients between 0 and 2 years) was associated with a better prognosis when compared with late onset (21 patients aged
more than 2 years), P=0.009. Serology typing of Human leukocyte antigens (HLA) classes I and II in 64 patients revealed a significantly higher
frequency of DR9 antigen (P=0.0037) and a lower frequency of DQ1 antigen (P=0.009) in D+HUS patients compared with healthy Czech blood donors. Conclusion: Our study demonstrates a high prevalence of late renal damage in Czech patients surviving after D+HUS. The HLA typing in our
group revealed a significantly higher rate of HLA DR9 haplotypes in D+HUS patients.
Received: 4 January 2001 / Revised: 9 October 2001 / Accepted: 2 January 2002 相似文献
15.
There is experimental evidence that loss of renal parenchyma results in hyperfiltration in the remnant glomeruli followed
by development of glomerulosclerosis. Microalbuminuria, i.e., a urinary albumin excretion rate of 20 – 200 μg/min, is considered
to be an early predictor of diabetic glomerulosclerosis. Hypothetically, increased urinary albumin excretion in patients with
pyelonephritic scarring may also indicate glomerulosclerosis, with risk for future deterioration of renal function. This study
was performed to determine the incidence of increased albumin excretion in children with mild to moderate pyelonephritic scarring,
and to relate the information to glomerular filtration rate (GFR; clearance of inulin) and effective renal plasma flow (clearance
of para-aminohippuric acid), as well as to the degree of scarring. The functional investigations were performed under water
diuresis. Fifty-seven children, aged 1.7 – 17.9 years, with pyelonephritic renal scarring were included in the study. Nine
young healthy adults were used as controls. The GFR was significantly lower in the children with pyelonephritic scarring than
in the controls (median 93 ml/min per 1.73 m2, range 48 – 133 vs. 111 ml/min per 1.73 m2, range 89 – 121, P<0.05), and the urine albumin excretion was significantly higher (median 20 μg/min per 100 ml GFR, range 0.8 – 170 vs. 9.2
μg/min per 100 ml GFR, range 3.3 – 21, P<0.05). An inverse correlation was found between urine albumin excretion and GFR. Increased urine albumin excretion was found
in 70% of the children with a GFR below 90 ml/min per 1.73 m2 compared with 41% of the children with a GFR above this level. Increased urine albumin excretion (>20 μg/min per 100 ml GFR)
was found in 51% of the children with pyelonephritic scarring, while only 14% had increased age-adjusted serum creatinine
concentrations. The high incidence of microalbuminuria in children with pyelonephritic scarring indicates long-term follow-up
until the ultimate outcome has been better defined.
Received January 17, 1995; received in revised form and accepted April 2, 1996 相似文献
16.
We sought to determine the prevalence of hyperinsulinemia and insulin resistance in pediatric patients with chronic kidney
disease (CKD) stages 2–4. Data were collected on 43 subjects, aged 6–21 years with mean glomerular filtration rate (GFR) = 47 ml/min
per 1.73 m2 body surface area. Patients were grouped by body mass index (BMI) as either non-lean (>85th percentile) or lean (≤85th percentile).
Fourteen (33%) subjects had hyperinsulinemia, and seven (16%) had elevated homeostasis model assessment of insulin resistance
(HOMA-IR). Non-lean subjects had a higher serum insulin level (21.0 μU/ml vs 13.4 μU/ml, P < 0.0001) and HOMA-IR (4.9 vs 3.2, P < 0.001) than lean subjects had. The prevalence of hyperinsulinemia was higher in non-lean patients (40%) than in lean patients
(29%) but was not statistically significant. High HOMA-IR was present in six (40%) non-lean subjects and in one lean subject
(P < 0.001). Correlation analysis demonstrated that serum insulin level was significantly associated with BMI, leptin and tumor
necrosis factor (TNF)-α. Stepwise regression determined that increased BMI (P = 0.003) and TNF-α (P = 0.01) independently predicted higher insulin level in the whole cohort. Separate analysis for lean subjects showed no significant
associations between serum insulin level and BMI; TNF-α was the only independent predictor of serum insulin (β = 1.11, P = 0.01). We conclude that hyperinsulinemia and insulin resistance are frequent in pediatric CKD. In lean patients inflammation
appears to be an important determinant of serum insulin level. 相似文献
17.
The purpose of the study was to explore associations between neurocognitive function and chronic kidney disease (CKD)-related
clinical characteristics. Twenty-nine children, ages 7 to 19 years, with an estimated creatinine clearance (eCrCl) of 4–89 ml/min
per 1.73 m2 body surface area were enrolled. Intellectual function (IQ), memory, and attention were measured and expressed as age-based
standard scores. Clinical data were obtained by physical examination, laboratory testing, parental questionnaires and medical
chart review. Pearson correlations and standard Student’s t-tests were used to identify significant (P < 0.05) relationships between targeted clinical variables and neurocognitive scores. Increased CKD severity correlated with
lower IQ (P = 0.001) and memory function (P = 0.02). Memory function was lower in children with longer duration of disease (P = 0.03). Similarly, IQ scores were lowest when kidney disease had started at a younger age (P = 0.03) and with a greater percent of life with CKD (P = 0.04). Our findings provide preliminary evidence that increased disease severity, longer duration of disease, and younger
age of onset of kidney disease potentially place children with CKD at increased risk of neurocognitive deficits. Additional
investigation is required to better quantify these risk factors, particularly regarding how much variability is accounted
for by these specific risk factors. 相似文献
18.
Furth SL Cole SR Fadrowski JJ Gerson A Pierce CB Chandra M Weiss R Kaskel F;Council of Pediatric Nephrology Urology New York/New Jersey;Kidney Urology Foundation of America 《Pediatric nephrology (Berlin, Germany)》2007,22(2):265-271
We sought to describe rates of kidney function decline and to identify modifiable risk factors for CKD progression in a multicenter
prospective cohort study of adolescents with CKD aged 11 to 18 years seen semiannually for up to three years. Of the 23 subjects
meeting inclusion criteria, the average estimated GFR was 51 ± 27 ml/min/1.73 m2 (0.85 ± 0.45 ml/s/1.73 m2) at entry. The overall annualized decline in GFR was 5.6 ml/min/1.73 m2 (0.093 ml/s/1.73 m2) per year (95% confidence interval [95% CI]: 1.9 to 9.3 [0.032 to 0.16]). The adjusted annualized decline in GFR was found
to be accelerated in males, as well as among those over 15 years of age. The adjusted annualized decline in GFR was greater
among those with either anemia (hematocrit below 36%), or hypoalbuminemia (albumin below 4 g/dl [40 g/L]). After adjustment,
anemia was associated with an accelerated decline of 7.8 ml/min/1.73 m2 (0.13 ml/s/1.73 m2) (95% CI: 3.3 to 12 [0.055 to 0.20]) and hypoalbuminemia was associated with an accelerated decline of 17 ml/min/1.73 m2 (0.28 ml/s/1.73 m2) (95% CI: 11 to 22 [0.18 to 0.37]). Further study is needed to evaluate whether treatment of anemia or hypoalbuminemia, as
outlined in current clinical care guidelines for CKD, may slow the progression of CKD in adolescents. 相似文献
19.
Imai E Horio M Iseki K Yamagata K Watanabe T Hara S Ura N Kiyohara Y Hirakata H Moriyama T Ando Y Nitta K Inaguma D Narita I Iso H Wakai K Yasuda Y Tsukamoto Y Ito S Makino H Hishida A Matsuo S 《Clinical and experimental nephrology》2007,11(2):156-163
Background The number of patients with end-stage renal disease (ESRD) in Japan has continuously increased in the past three decades.
In 2005, 36 063 patients whose average age was 66 years entered a new dialysis program. This large number of ESRD patients
could be just the tip of the iceberg of an increasing number of patients with chronic kidney disease (CKD). However, to date,
a nationwide epidemiological study has not been conducted yet to survey the CKD population.
Methods Data for 527 594 (male, 211 034; female, 316 560) participants were obtained from the general adult population aged over 20
years who received annual health check programs in 2000–2004, from seven different prefectures in Japan: Hokkaido, Fukushima,
Ibaraki, Tokyo, Osaka, Fukuoka, and Okinawa prefectures. The glomerular filtration rate (GFR) for each participant was estimated
from the serum creatinine values, using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation modified
by the Japanese coefficient.
Results The prevalences of CKD stage 3 in the study population, stratified by age groups of 20–29, 30–39, 40–49, 50–59, 60–69, 70–79,
and 80–89 years, were 1.4%, 3.6%, 10.8%, 15.9%, 31.8%, 44.0%, and 59.1%, respectively, predicting 19.1 million patients with
stage 3 CKD in the Japanese general adult population of 103.2 million in 2004. CKD stage 4 + 5 was predicted in 200 000 patients
in the Japanese general adult population. Comorbidity of hypertension, diabetes, and proteinuria increased as the estimated
GFR (eGFR) decreased. The prevalence of concurrent CKD was significantly higher in hypertensive and diabetic populations than
in the study population overall when CKD was defined as being present with an eGFR of less than 40 ml/min per 1.73 m2 instead of less than 60 ml/min per 1.73 m2.
Conclusions About 20% of the Japanese adult population (i.e., approximately 19 million people) are predicted to have stage 3 to 5 CKD,
as defined by a GFR of less than 60 ml/min per 1.73 m2.
This work was presented in part at the 48th annual meeting of the Japanese Society of Nephrology at Yokohama in 2005. 相似文献
20.
Raes A Donckerwolcke R Craen M Hussein MC Vande Walle J 《Pediatric nephrology (Berlin, Germany)》2007,22(11):1903-1909
Increased glomerular filtration rate (GFR) has been implicated in the development of diabetic nephropathy. Large normal interindividual
variations of GFR hamper the diagnosis of renal hemodynamic alterations. We examined renal functional reserve (RFR) in children
with type 1 diabetes mellitus to assess whether hyperfiltration occurs. The renal hemodynamic response following dopamine
infusion was examined in 51 normoalbuminuric diabetic children (7.7 ± 3.6 years) with a mean duration of diabetes of 6.2 years
and compared them with 34 controls. Mean baseline GFR in diabetic children did not differ from the control population (130.7 ± 22.9
vs. 124.8 ± 25 ml/min per 1.73 m2), whereas renal plasma flow was significantly lower (463.7 ± 103.9 vs. 587.2 ± 105 ml/min per 1.73 m2, p < 0.001), and filtration fraction was increased (29 ± 8 vs. 21 ± 2%, p < 0.001), compared with controls. The mean RFR was lower (p < 0.001) than in control subjects (−0.77 ± 23 vs. 21 ± 8 ml/min per 1.73 m2). This study documents an increased filtration fraction and reduced or absent RFR in children with type 1 diabetes mellitus
in the stage before apparent nephropathy. GFR values were within normal range. Although the reduced RFR and increased filtration
fraction indicate the presence of hemodynamic changes, their relevance to the development of hyperfiltration and subsequent
diabetic nephropathy remains unknown. 相似文献