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Pathogenesis and Assessment of Renal Function in Patients With Liver Cirrhosis

dysfunction and hepato-renal failure in liver disease. Hepatology 1994;20:362-9. 18. Proulx NL, Akbari A, Garg AX, et al. Measured creatinine clearance from timed urine collections substantially overestimates glomerular filtration rate in patients with liver cirrhosis: a systematic review and individual patient meta-analysis. Nephrol Dial Transplant 2005;20:1617-22. 19. Sherman DS, Fish DN, Òeitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis 2003;41:269-78. 20. Stevens LA

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Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure


Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%.

Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance).

Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring.

Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items.

Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

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Restoration of renal perfusion and function in chronic kidney disease


Background: Present treatment with vasodilators usually initiated at the late stage of chronic kidney disease (CKD) fails to restore renal perfusion and function. This may be due to impaired mechanism of nitric oxide production, while the mechanism of vascular repair appears to be adequately functional in the early stage of CKD.

Objective: Investigate restoration of renal perfusion and function in CKD patients by implementing vasodilators treatment at the early stage of CKD.

Methods: Vasodilators treatment was implemented in 65 CKD patients (33 males and 32 females) at the early stage of CKD. The patients aged 28-71 years old, and were associated with mildly impaired renal function (mean creatinine clearance: 83±21 mL/min/1.73m2, fractional excretion of magnesium (FE Mg): 4±2% vs. normal 1.6±0.6%, total urinary protein: 85±12 mg/day, renal plasma flow (RPF): 459±59 mL/min/1.73m2, glomerlular filtration rate (GFR): 84±25 mL/min/1.73m2, peritubular capillary flow (PTCF): 332 mL/min/1.73m2). Treatment included vasodilators as follows, angiotensin converting enzyme inhibitor (ACEI) 5-20 mg/day, angiotensin II receptor blockers (ARB) 40-80 mg/day, and calcium channel blocker 5-10 mg/day for 12-24 months.

Results: Following the treatment, actual creatinine clearance rose to 101±23 mL/min/1.73m2, and FE Mg and total urinary protein declined to 3±2 % and 46±7 mg/day, respectively. RPF, GFR and PTCF significantly rose to 513±90 mL/min/1.73m2, 99±33 mL/min/1.73m2 and 413±73 mL/min/1.73m2, respectively.

Conclusion: Treatment with vasodilators at the early stage of CKD could restore renal perfusion and function.

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An adjustment of vancomycin dosing regimen for a young patient with augmented renal clearance: A case report / Úprava dávkového režimu vankomycínu pre mladého pacienta so zvýšeným renálnym klírensom: Kazuistika

comparison of estimates of glomerular filtration in critically ill patients with augmented renal clearance. Crit Care. 2011;15(3):R139. [7] Cook AM, Arora S, Davis J, Pittman T. Augmented renal clearance of vancomycin and levetiracetam in a traumatic brain injury patient. Neurocrit Care. 2013;19(2):210-14. [8] Udy A,Boots R, Senthuran S, Stuart J, Deans R, Lassig-Smith M, Lipman J. Augmented creatinine clearance in traumatic brain injury. Anesth Analg. 2010;111(6):1505-10. [9] Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman

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Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

References Grubb AO. Cystatin C — properties and use as diagnostic marker. Adv Clin Chem 2000; 35: 63-99. Finney H, Newman DJ, Price CP. Adult reference ranges for serum cystatin C, creatinine and predicted creatinine clearance. Ann Clin Biochem 2000; 37: 49-59. Swan SK. The search continues — an ideal marker of GFR [Editorial]. Clin Chem 1997; 43: 913-14. Tanaka A, Suemaru K, Araki H. A new approach for evaluating renal function and its practical

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Predisposing factors for chemotherapy-induced nephrotoxicity in patients with advanced esophageal cancer who received combination chemotherapy with docetaxel, cisplatin, and 5-fluorouracil

therapy was received as initial chemotherapy, and 3) a diagnosis of clinical stage IB to III disease according to the seventh edition of the TNM classification by the Union for International Cancer Control. The exclusion criteria were as follows: 1) active double cancer in another organ, 2) a history of treatment for cancer in another organ, 3) use of a reduced dose of anticancer agents from the time of initial treatment, 4) concomitant treatment with radiotherapy, 5) nephrotoxicity (creatinine clearance [Ccr] <60 mL/min) or liver dysfunction (aspartate aminotransferase

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The use of Monte Carlo simulation to predict vancomycin dosage for methicillin-resistant Staphylococcus aureus in Thai patients of various ages and with varying degrees of renal function

pharmacokinetics in Thai patients [ 6 ]. The study illustrated that creatinine clearance (CL cr ) calculated by the Cockcroft–Gault equation and age were covariates of vancomycin clearance (CL v ) and volume of the central compartment ( V c ), respectively. Thus, suitable vancomycin dosage could vary depending on CL cr and age. In addition, MRSA susceptibility data to vancomycin is a crucial factor for evaluating proper vancomycin dosing. Canut et al. determined suitable vancomycin dosages for European patients with MRSA infection [ 7 ]. The study revealed that Belgian patients

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Improved vascular repair is relevant to enhanced renal function with vasodilators in early stage of chronic kidney disease


Background: Treatment with vasodilators can improve renal function in early stage of chronic kidney disease (CKD) patients. Objective: Study the mechanism of vascular repair in 20 CKD patients associated with actual creatinine clearance greater than 60 mL/min/1.73m2 (mean 84+24 mL/min/1.73m2) who had been under treatment with vasodilators. Results: Initial study on angiogenic factors revealed a low value of VEGF, no significant change in VEGF-R1, whereas antiangiogenic factors showed elevated angiopoietin-2 and no significant change in VEGF-R2. Initial actual creatinine clearance was significantly depleted and fractional excretion of magnesium (FE Mg) was elevated significantly. Follow-up study showed improved VEGF and a significant decline in angiopoietin-2. Such improved vascular repair coincided with enhanced creatinine clearance. Conclusion: Improved renal function can be achieved by vasodilators under environment favourable for adequate vascular repair.

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A folic acid-induced rat model of renal injury to identify biomarkers of tubulointerstitial fibrosis from urinary exosomes

). Because SCr does not reach a steady state during acute kidney injury, we directly calculated creatinine clearance (CCr) from 24 h urine collection of UCr. The CCr was calculated using the following equation: CCr = (UCr * 24 h urine volume)/SCr. For histology, kidneys were fixed in 10% neutral buffered formalin solution for paraffin embedding and sectioning (4 mm thickness), then stained using a Masson trichrome method. TI fibrosis was evaluated at 200 × magnification by the following semiquantitative criteria to estimate area of damage: 0, <5%; 1, 5%-10%; 2, 11

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The problem of low peak concentration of gentamicin in clinical practice

Chronic Kidney Dis. 17, 5, 2010, p. 53 - 62. SALAZAR, D., E. - CORCORAN, G., B.: Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat free body mass. Am J Med 84, 6, 1988, p. 1053 - 1060. DHILLON, S. - KOSTRZEWSKI, A.: Clinical Pharmacokinetics. 1 st edition London, Chicago: Pharmaceutical Press, Publishing, 2006, p. 262. TOD, M., M. - PADOIN, C. - PETITJEAN, O.: Individualising aminoglycosides dosage regimens after therapeutic drug monitoring: simple

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