Age Changes in Glomerular Filtration Rate, Effective Renal Plasma Flow, and Tubular Excretory Capacity in Adult Males

Davies, Dean F.; Shock, N. W.

doi:10.1172/jci102286

Cited by 1,032 publications

(453 citation statements)

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“…It should be noted that urinary concentrations of human epidydimis secretory protein 4 concentrations may be affected by renal function, because glomerular filtration rate decreases with age (Davies et al, 1950). For that reason, older women with reduced glomerular filtration rate are expected to have lower HE4 concentration in urine, compared with patients whose glomerular filtration rate is normal.…”

Section: Discussionmentioning

confidence: 99%

Urinary Concentrations of Human Epidydimis Secretory Protein 4 (He4) in The Diagnosis of Ovarian Cancer: A Case-Control Study

Macuks

Baidekalna²,

Doniņa³

2012

Asian Pacific Journal of Cancer Prevention

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Objective: To analyze differential diagnostic accuracy of urinary human epidydimis secretory protein 4 (HE4) in patients with ovarian tumors. Materials and methods: In the case-control study 23 patients with ovarian cancer, 37 patients with benign ovarian tumors and 18 women in the control group were included. Serum CA125 values and urinary concentrations of HE4were assessed quantitatively. Urinary creatinine concentrations and glomerular filtration rate were also determined and used to calculate ratios to HE4. Results: Higher urinary HE4 concentrations were observed in patients with late stage ovarian cancer (p=0.001) and also in patients with early stage ovarian cancer when compared to patients with benign ovarian tumors (p=0.044). On analysis where all ovarian cancer patients were included, higher diagnostic accuracy was observed with calculated ratio of HE4 to glomerular filtration rate (GFR) to unchanged urinary HE4 concentrations -AUC 0.861 vs. 0.858. When discriminatory accuracy was calculated for urinary HE4/GFR ratio and unchanged urinary HE4 concentrations, the last demonstrated a higher area under the curve -0.701 vs. 0.602. The urinary HE4/creatinine ratio had lower discriminatory characteristics than unchanged concentrations of urinary HE4. However, HE4 serum concentration was more accurate for discrimination of patients with benign and malignant ovarian tumors when compared to urinary HE4 and CA125 in sera (AUCs were 0.868 for serum HE4 and 0.856 and 0.653 for urinary HE4 and CA125, respectively). Conclusions: Ovarian cancer patients have higher urinary concentrations of human epidydimis secretory protein 4 than patients with benign ovarian tumors. Urinary HE4 has comparable discriminatory accuracy with serum HE4 for benign and malignant ovarian tumors and can be recommended as a non-invasive ovarian cancer risk assessment method.

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Section: Discussionmentioning

confidence: 99%

Urinary Concentrations of Human Epidydimis Secretory Protein 4 (He4) in The Diagnosis of Ovarian Cancer: A Case-Control Study

Macuks

Baidekalna²,

Doniņa³

2012

Asian Pacific Journal of Cancer Prevention

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“…FG menor que 60mL/min/1,73m 2 representa diminuição de cerca de 50% da função renal normal e, abaixo deste nível, aumenta a prevalência das complicações da DRC. [6][7][8] Embora a diminuição da FG relacionada à idade possa dever-se ao processo de envelhecimento normal, a diminuição da FG no idoso é um preditor independente de evolução adversa da doença, tal como óbito e doença cardiovascular. [9][10][11] Além do mais, a FG diminuída no idoso deve implicar em ajustes nas dosagens das medicações, semelhantemente ao que se faz em todos os pacientes com DRC.…”

Section: Diagnóstico Da Drc Avaliação Da Filtração Glomerularunclassified

Doença renal crônica: frequente e grave, mas também prevenível e tratável

Bastos

Bregman²,

Kirsztajn³

2010

Rev. Assoc. Med. Bras.

180

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ResumoA doença renal crônica é considerada problema de saúde pública em todo o mundo. No Brasil, a incidência e a prevalência de falência de função renal estão aumentando; o prognóstico ainda é ruim e os custos do tratamento da doença são altíssimos. Independentemente da etiologia da doença de base, os principais desfechos em pacientes com DRC são as suas complicações (anemia, acidose metabólica, desnutrição e alteração do metabolismo de cálcio e fósforo), decorrentes da perda funcional renal, óbito (principalmente, por causas cardiovasculares) e perda de função renal. Estudos recentes indicam que estes desfechos indesejados podem ser prevenidos ou retardados se a DRC for diagnosticada precocemente e as medidas nefro e cardioprotetoras implementadas o mais rápido possível. O atual estagiamento da doença e uma descrição dessas medidas preventivas são apresentados na presente revisão. Artigo de Revisão introduçãoA nova definição da doença renal crônica (DRC), em uso desde 2002, propiciou um estagiamento da doença que independe da sua causa. A partir desta nova abordagem, ficou evidente que a DRC é muito mais frequente do que até então se considerava e sua evolução clínica está associada a taxas altas de morbimortalidade. 1 Os rins são órgãos fundamentais para a manutenção da homeostase do corpo humano. Assim, não é surpresa constatarmos que, diminuição progressiva da função renal, implique em comprometimento de essencialmente todos os outros órgãos. A função renal é avaliada pela filtração glomerular (FG) e a sua diminuição é observada na Doença Renal Crônica (DRC), associada a perda das funções regulatórias, excretórias e endócrinas do rim. Quando a FG atinge valores muito baixos, inferiores a 15 mL/min/1,73m 2 , estabelece-se o que denominamos falência funcional renal (FFR), ou seja, o estágio mais avançado do continuum de perda funcional progressiva observado na DRC.A DRC é, atualmente, considerada um problema de saúde pública mundial. No Brasil, a incidência e a prevalência de FFR estão aumentando, o prognóstico ainda é ruim e os custos do tratamento da doença são altíssimos. O número projetado atualmente para pacientes em tratamento dialítico e com transplante renal no Brasil está próximo dos 120.000, a um custo de 1,4 bilhão de reais. 2 Independentemente da doença de base, os principais desfechos em pacientes com DRC são as suas complicações (anemia, acidose metabólica, alteração do metabolismo mineral e desnutrição), decorrentes da perda funcional renal, óbito (principalmente por causas cardiovasculares) e FFR. Estudos recentes indicam que estes desfechos indesejados podem ser prevenidos ou retardados se a DRC for diagnosticada precocemente e as medidas nefro e cardioprotetoras implementadas precocemente. 1,3-5 Infelizmente, a DRC é subdiagnosticada e tratada inadequadamente, resultando na perda de oportunidade para a implementação de prevenção primária, secundária e terciária, em parte devido à falta de conhecimento da definição e classificação dos estágios da doença, bem como a não utilização de testes s...

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“…Although it is indisputable that function of the kidneys decrease with increasing age, 38,39 such data on liver function and physiology are often contradictory. 40 Decreases in organ weight and liver blood flow 16,41 are the best documented age-related alterations, but because of the liver's great functional reserve and the ability to regenerate, these changes do not correlate well with functional deterioration when there is no concomitant pathology.…”

Section: Discussionmentioning

confidence: 99%

Effect of donor age and sex on the outcome of liver transplantation*1

et al. 1995

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We correlated donor and recipient factors with graft outcome in 436 adult patients who underwent 462 liver transplants. Donor variables analyzed were age, gender, ABO blood group, cause of death, length of stay in the intensive care unit, use of pressors or pitressin, need for cardiopulmonary resuscitation, terminal serum transaminases, and ischemia time. Recipient variables analyzed were age, gender, primary diagnosis, history of previous liver transplant, ABO blood group, cytotoxic antibody crossmatch, United Network for Organ Sharing (UNOS) status, and waiting time (except for the cross-match results, they were all known at the time of the operation). The endpoint of the analysis was graft failure, defined as patient death or retransplantation. Using multivariate analysis, graft failure was significantly associated with donor age, donor gender, previous liver transplantation, and UNOS 4 status of the recipient. The effect of donor age became evident only when they were older than 45 years. Livers from female donors yielded significantly poorer results, with 2-year graft survival of female to male 55% (95% CI, 45% to 67%); female to female, 64% (95% CI, 54% to 77%); male to male, 72% (95% CI, 66% to 78%); and male to female, 78% (95% CI, 70% to 88%). The only donors identified as questionable for liver procurement were old (≥60 years) women in whom the adverse age and gender factors were at least additive. However, rather than discard even these livers, in the face of an organ shortage crisis, their individualized use is suggested with case reporting in a special category.As of January 4, 1995, 37,751 transplant candidates were registered on the national waiting list operated by the United Network for Organ Sharing (UNOS), the agency that coordinates organ allocation in the United States. This was a 391% increase from the 9,632 waiting in December 1986. Of the 37,751 in 1995, 4,039 were liver candidates, up from 449 in 1987 (a 900% increase). The supply of all organ donors had undergone a marginal increase between 1988 and 1990 (from 4,085 to 4,514), but has remained relatively stable since then: 4,531 in 1991, 4,521 in 1992, 4,849 in 1993, and 4,891 in 1994. The limited supply of organ donors has increasingly influenced the selection of candidates for liver transplantation, and is used at some institutions to justify restricting the availability of the procedure. 1 Although the exact magnitude of the organ deficit is not yet known, 2,3 the obvious gap between supply and need has stimulated the development of bioartificial liver assist devices, 4 utilization of living related liver donors, 5,6 use of non-heart beating donors, 7-9 and 18,19 or beyond 20 was followed by a flurry of confirmatory reports, 13,14,21,22 countered by descriptions of degraded results using geriatric livers. [23][24][25][26] Less has been written about the effect of donor sex on outcome after liver transplantation, although there is an extensive literature, recently summarized by Neugarten and Silbiger, 27 showing poorer re...

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Age Changes in Glomerular Filtration Rate, Effective Renal Plasma Flow, and Tubular Excretory Capacity in Adult Males

Cited by 1,032 publications

References 5 publications

Urinary Concentrations of Human Epidydimis Secretory Protein 4 (He4) in The Diagnosis of Ovarian Cancer: A Case-Control Study

Urinary Concentrations of Human Epidydimis Secretory Protein 4 (He4) in The Diagnosis of Ovarian Cancer: A Case-Control Study

Doença renal crônica: frequente e grave, mas também prevenível e tratável

Effect of donor age and sex on the outcome of liver transplantation*1

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