scholarly journals Renal Function Assessment Gap in Clinical Practice: An Awkward Truth

2020 ◽  
Vol 45 (2) ◽  
pp. 166-179 ◽  
Author(s):  
Francesco Trevisani ◽  
Federico Di Marco ◽  
Umberto Capitanio ◽  
Alessandro Larcher ◽  
Arianna Bettiga ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Practice ◽  
Plasma Clearance ◽  
Renal Scintigraphy ◽  
Study Cohort ◽  
Clinical Settings ◽  
Gold Standard Method ◽  
Disease Epidemiology ◽  
Iohexol Plasma Clearance ◽  
Gold Standards

Introduction: An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). Objective: The objective of the study is to determine the extent of the error of eGFR formulas compared to the mGFR in different specific clinical settings. Methods: A total retrospectively consecutive cohort of 1,320 patients (pts) enrolled in 2 different European Hospitals (Center 1: 470 pts; Center 2: 850 pts) was collected in order to compare the most common eGFR formulas used by physicians with the most widespread mGFR methods in daily clinical practice (Iohexol Plasma Clearance -Center 1 [mGFR-iox] and Renal Scintigraphy -Center 2 [mGFR-scnt]). The study cohort was composed by urological, oncological, and nephrological pts. The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference) accuracy (as P30), and total deviation index. Results: The most accurate eGFR formula in the comparison with gold standard method (Iohexol plasma clearance) in Center 1 was represented by s-creatinine and cystatin C combined Chronic Kidney Disease-Epidemiology Collaboration-cr-cy, even though the P30 is reduced (84%) under the threshold of 60 mL/min/1.73 m2. Similar results were found in Center 2, with a wider discrepancy between mGFR-scnt and eGFR formulas due to the minor accuracy of the nuclear tool in respect to the mGFR-iox. Conclusions: The loss of accuracy observed for the formulas at lower values of GFR suggests the mandatory use of gold standards methods as Iohexol Plasma Clearance to assess the correct status of renal function for critical cases. The center 2 showed lower levels of agreement between mGFR and eGFR suggesting that the errors are partially accounted for the Renal Scintigraphy technique too. In particular, we suggest the use of mGFR-iox in oncological urological and nephrological pts with an eGFR lower than 60 mL/min/1.73 m2.

scholarly journals Evolution of renal function in patients with severe intestinal failure on home parenteral nutrition

2020 ◽  
Author(s):  
Elodie Chalencon ◽  
Laetitia Koppe ◽  
Madeleine Lauverjat ◽  
Didier Barnoud ◽  
Denis Fouque ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Parenteral Nutrition ◽  
Intestinal Failure ◽  
Significant Risk ◽  
Home Parenteral Nutrition ◽  
Predisposing Factor ◽  
Gold Standard Method ◽  
Renal Function Decline ◽  
Disease Epidemiology

Abstract Background Kidney disease is a frequent but underestimated complication in patients suffering from intestinal failure (IF) treated by long-term home parenteral nutrition (HPN). The evolution in glomerular filtration rate (GFR) over time is poorly characterized. The current equations for estimating GFR have limited precision. No study has specifically investigated the reliability of recent creatinine-based estimated GFR (eGFR) equations in this population. The aim of this study was to evaluate the renal function decline under home parenteral nutrition (HPN) with a gold standard method and compare the performances of routinely used eGFR equations. Methods Forty patients with HPN and two or more GFR measurements were retrospectively studied. The renal function decline was calculated by the slope drawn between the successive measured GFRs (mGFRs). The performances of the Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration, full age spectrum and revised Lund–Malmö equations were compared with reference methods (inulin or iohexol clearance). Results The mean mGFR was 78 ± 28 mL/min/1.73 m2. The annual decline of mGFR was −1.9 mL/min/1.73 m2/year. No predisposing factor was identified to predict impairment in renal function. eGFR formulas grossly overestimated mGFR and had a low level of accuracy. Conclusions Patients with IF are at significant risk for impaired renal function. In this population, the tested eGFR equations were inaccurate. However, monitoring kidney function with mGFR remains important in these patients, as their GFR regularly declines and no specific risk factor has yet been identified.

scholarly journals Model-Based Estimation of Iohexol Plasma Clearance for Pragmatic Renal Function Determination in the Renal Transplantation Setting

2021 ◽  
Author(s):  
Tom C. Zwart ◽  
Aiko P. J. de Vries ◽  
Aline G. J. Engbers ◽  
Ruth E. Dam ◽  
Paul J. M. van der Boog ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Transplantation ◽  
Plasma Clearance ◽  
Model Based ◽  
Iohexol Plasma Clearance

Iohexol Plasma Clearance in Animal Models: The Clear Choice for Measuring Early Renal Dysfunctio

2018 ◽  
Author(s):  
Mandy Turner
Keyword(s):  
Renal Function ◽  
Animal Models ◽  
Kidney Function ◽  
Kidney Failure ◽  
Plasma Clearance ◽  
Inulin Clearance ◽  
Plasma Creatinine ◽  
Creatinine Concentration ◽  
Plasma Creatinine Concentration ◽  
Iohexol Plasma Clearance

Glomerular filtration rate is a measure of the kidney’s ability to filter blood. In animal models of early kidney failure, there is no routine method to accurately measure GFR. The expensive gold standard of GFR measurement is exogenous inulin clearance. The commonly used method, endogenous plasma creatinine concentration, is unreliable and insensitive, especially at normal levels of renal function. This study investigates the utility of iohexol, an inexpensive radio-contrast agent as a promising exogenous marker for plasma clearance kidney function evaluation in rats. Early stages of progressive kidney failure were induced with a 0.25% adenine diet in male Sprague Dawley rats (N=8) over 5 weeks. Both plasma clearance of iohexol and inulin and creatinine concentration were evaluated following weekly venous injections and blood sampling. Plasma iohexol clearance and plasma inulin clearance strongly correlate (R2=0.95). However, plasma creatinine concentration correlated weakly with iohexol(R2=0.53) and inulin(R2=0.58). Iohexol plasma clearance accurately measures changes in kidney function, especially in in comparison to creatinine analysis. The data demonstrates creatinine is an inappropriate marker for renal function in early adenine-induced CKD rat models. Ongoing analysis of this data suggests refinement of the protocol will yield a simple method for routine measure of kidney function in murine lab animals. This tool will facilitate advancement in kidney disease onset and allow for more accurate interpretation of kidney function in the various animal models.

Iohexol plasma clearance, a simple and reliable method to measure renal function in conscious mice

2016 ◽  
Vol 468 (9) ◽  
pp. 1587-1594 ◽  
Author(s):  
Sergio Luis-Lima ◽  
Ana Elena Rodríguez-Rodríguez ◽  
Cristina Martín-Higueras ◽  
Catalina Sierra-Ramos ◽  
Fabiola Carrara ◽  
...  
Keyword(s):  
Renal Function ◽  
Plasma Clearance ◽  
Reliable Method ◽  
Iohexol Plasma Clearance

scholarly journals FP232VALIDATION OF IOHEXOL PLASMA CLEARANCE AS AN ACCURATE AND SENSITIVE MARKER OF RENAL FUNCTION IN RAT MODELS

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii144-iii145
Author(s):  
Mandy Turner ◽  
Kim Laverty ◽  
Martin Kaufmann ◽  
Glenville Jones ◽  
Christine White ◽  
...  
Keyword(s):  
Renal Function ◽  
Plasma Clearance ◽  
Rat Models ◽  
Iohexol Plasma Clearance ◽  
Sensitive Marker

1905: The Effect of Percutaneous Nephrolithotripsy (PCNL) on Renal Function: Assessment with Quantitative Spect of TC 99M-DMSA (QDMSA) Renal Scintigraphy

2004 ◽  
Vol 171 (4S) ◽  
pp. 503-503
Author(s):  
Boaz Moskovitz ◽  
Vladimir Sopov ◽  
Sarel Halachmi ◽  
Michael Mullerad ◽  
Yusef Barbara ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Scintigraphy ◽  
Quantitative Spect ◽  
Percutaneous Nephrolithotripsy ◽  
Function Assessment

Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available

2020 ◽  
Vol 78 (10) ◽  
pp. 642-650
Author(s):  
Felipe Torres PACHECO ◽  
Luiz Celso Hygino da CRUZ JUNIOR ◽  
Igor Gomes PADILHA ◽  
Renato Hoffmann NUNES ◽  
Antônio Carlos Martins MAIA JUNIOR ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Vessel Wall ◽  
Vascular Diseases ◽  
Vascular Wall ◽  
Vessel Wall Imaging ◽  
Clinical Settings ◽  
Direct Evaluation ◽  
Intracranial Vessel ◽  
Indirect Evaluation ◽  
Wall Imaging

ABSTRACT Intracranial vessel wall imaging plays an increasing role in diagnosing intracranial vascular diseases. With the growing demand and subsequent increased use of this technique in clinical practice, radiologists and neurologists should be aware of the choices in imaging parameters and how they affect image quality, clinical indications, methods of assessment, and limitations in the interpretation of these images. Due to the improvement of the MRI techniques, the possibility of accurate and direct evaluation of the abnormalities in the arterial vascular wall (vessel wall imaging) has evolved, adding substantial data to diagnosis when compared to the indirect evaluation based on conventional flow analyses. Herein, the authors proposed a comprehensive approach of this technique reinforcing appropriated clinical settings to better use intracranial vessel wall imaging.

Theory-Practice Gap: The Experiences of Nigerian Nursing Students

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Titilayo Dorothy Odetola ◽  
Olusola Oluwasola ◽  
Christoph Pimmer ◽  
Oluwafemi Dipeolu ◽  
Samson Oluwayemi Akande ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nursing Students ◽  
Developing Country ◽  
The Body ◽  
Clinical Staff ◽  
Clinical Settings ◽  
Practice Gap ◽  
The Difference ◽  
Analyse Data ◽  
Theory Practice Gap

The “disconnect” between the body of knowledge acquired in classroom settings and the application of this knowledge in clinical practice is one of the main reasons for professional fear, anxiety and feelings of incompetence among freshly graduated nurses. While the phenomenon of the theory-to-practice gap has been researched quite extensively in high-income country settings much less is known about nursing students’ experiences in a developing country context. To rectify this shortcoming, the qualitative study investigated the experiences of nursing students in their attempt to apply what they learn in classrooms in clinical learning contexts in seven sites in Nigeria. Thematic content analysis was used to analyse data gained from eight focus group discussions (n = 80) with the students. The findings reveal a multifaceted theory-practice gap which plays out along four tensions: (1) procedural, i.e. the difference between practices from education institutions and the ones enacted in clinical wards – and contradictions that emerge even within one clinical setting; (2) political, i.e. conflicts that arise between students and clinical staff, especially personnel with a lower qualification profile than the degree that students pursue; (3) material, i.e. the disconnect between contemporary instruments and equipment available in schools and the lack thereof in clinical settings; and (4) temporal, i.e. restricted opportunities for supervised practice owing to time constraints in clinical settings in which education tends to be undervalued. Many of these aspects are linked to and aggravated by infrastructural limitations, which are typical for the setting of a developing country. Nursing students need to be prepared regarding how to deal with the identified procedural, political, material and temporal tensions before and while being immersed in clinical practice, and, in so doing, they need to be supported by educationally better qualified clinical staff.

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