Creatinine Clearance in Patients With Proteinuria

Hilton, P. J.; Roth, Z; Lavender, S.; Jones, N. F.

doi:10.1016/s0140-6736(69)90751-x

Cited by 21 publications

(12 citation statements)

References 8 publications

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“…Although it has been known that serum markers of renal function remain in the reference range when there has already been a decline of GFR [10], the present observations indicate that especially in patients suffering from CD or DMIH, normal [creat] misguides about the state of renal function or predictable renal tolerance towards the toxic effects of high-dose Cp. Estimation of Ccreat might provide more valuable information and predict more reliably the risk of nephrotoxicity.…”

Section: Thoracic Oncology C Máthé Et Almentioning

confidence: 53%

“…However, in aged cancer patients [creat] and the concentration of urea may be only pseudonormal because of decreased muscle mass and protein intake, respectively. In conditions with reduced production of creatinine and low [creat], abnormally low glomerular filtration rate (GFR) may occur for extended periods before [creat] will reach the upper limit of the reference range [10]. Increased [creat] is to be considered the least sensitive indicator of reduced GFR [10].…”

mentioning

confidence: 99%

“…In conditions with reduced production of creatinine and low [creat], abnormally low glomerular filtration rate (GFR) may occur for extended periods before [creat] will reach the upper limit of the reference range [10]. Increased [creat] is to be considered the least sensitive indicator of reduced GFR [10]. Still, based on normal serum indices of renal function, aged CD or DMIH patients may receive full-dose Cp treatment for lung cancer.…”

mentioning

confidence: 99%

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Cisplatin nephrotoxicity aggravated by cardiovascular disease and diabetes in lung cancer patients

Máthé¹,

Bohács²,

Duffek³

et al. 2010

Eur Respir J

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Ageing lung cancer patients may be at increased risk of Cisplatin (Cp) nephrotoxicity, because of comorbidities leading to accelerated ageing of the kidneys. Therefore, the Cp-induced impairement of renal function was compared between no comorbidity (NC) and hypertension plus ischaemic heart disease (CD) patients or others having diabetes mellitus plus ischaemic heart disease (DMIH).In a preliminary study, glomerular filtration rate (GFR) was measured by clearance of technetium 99m-labelled diethylene-thiamine penta-acetate in 38 lung cancer patients with normal serum creatinine concentration ([creat]). Then, the incidence of nephrotoxicity was analysed retrospectively over 1st-4th cycles of Cp treatment among 242 lung cancer patients with initially normal [creat]. GFR was repeatedly estimated using calculated creatinine clearance.Pre-treatment GFR was 57¡3 mL?min -1 ?m -2 in those with normal (n515) and 42¡2 mL?min (n552) subgroups. Within the overall dropout rate from further Cp chemotherapy, nephrotoxicity was responsible in 14% of NC, 38% in CD and 75% in DMIH patients. A major portion of our ageing lung cancer patients suffered from comorbidities leading to reduced renal resistance to Cp nephrotoxicity.

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Section: Thoracic Oncology C Máthé Et Almentioning

confidence: 53%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Cisplatin nephrotoxicity aggravated by cardiovascular disease and diabetes in lung cancer patients

Máthé¹,

Bohács²,

Duffek³

et al. 2010

Eur Respir J

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“…Differences in the extent of tubular secretion may also contribute to the variability of bound solute concentrations in patients with residual function. Theoretically, secretion could be enhanced in association with adaptive tubular hypertrophy or impaired by the accumulation of competing solutes in uremic plasma (31,32). This issue has been studied remarkably little, but Van Olden et al (33) found that the ratio of para-amino hippurate clearance to GFR was reduced below normal in hemodialysis patients with residual function.…”

Section: Discussionmentioning

confidence: 99%

Contribution of Residual Function to Removal of Protein-Bound Solutes in Hemodialysis

Marquez

Tambra

Luo

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study evaluated the contribution of residual function to the removal of solutes for which protein binding limits clearance by hemdialysis.Design, setting, participants, & measurements Solute concentrations were measured in 25 hemodialysis patients with residual urea clearances ranging from 0.1 to 6.2 ml/min per 1.73 m 2 . Mathematical modeling assessed the effect of residual function on time-averaged solute concentrations.Results Dialytic clearances of the protein-bound solutes p-cresol sulfate, indoxyl sulfate, and hippurate were reduced in proportion to the avidity of binding and averaged 8 Ϯ 2, 10 Ϯ 3, and 44 Ϯ 13% of the dialytic urea clearance. For each bound solute, the residual clearance was larger in relation to the residual urea clearance. Residual kidney function therefore removed a larger portion of each of the bound solutes than of urea. Increasing residual function was associated with lower plasma levels of p-cresol sulfate and hippurate but not indoxyl sulfate. Wide variation in solute generation tended to obscure the dependence of plasma solute levels on residual function. Mathematical modeling that corrected for this variation indicated that increasing residual function will reduce the plasma level of each of the bound solutes more than the plasma level of urea. ConclusionsIn comparison to urea, solutes than bind to plasma proteins can be more effectively cleared by residual function than by hemodialysis. Levels of such solutes will be lower in patients with residual function than in patients without residual function even if the dialysis dose is reduced based on measurement of residual urea clearance in accord with current guidelines.

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“…Creatinine excretion is also increased by intensive physical exercise (Doolan et al, 1962) and a considerable day to day, withinsubject variation in creatinine excretion has also been demonstrated with a coefficient of variation of 10 to 15% (Greenblatt et al, 1976). Hilton et al (1969) found no correlation between the degree of proteinuria and the ratio between inulin and creatinine clearance. Although normally carried out over 24 h it has been shown that a one hour urine collection gives comparable results provided bladder emptying is complete (Richardson & Philbin, 1971).…”

Section: Inulin Clearancementioning

confidence: 99%