Acute kidney injury in patients with chronic liver disease.

Acute kidney injury (AKI) is a frequent clinical event in patients with liver disease, compounding their prognosis. Furthermore, it is likely that the occurrence of AKI has a detrimental impact on the subsequent renal function and the long-term survival of these patients. Recently, some authors advocated the use of new diagnostic criteria for detecting acute kidney injury in patients with cirrhosis.

Postconditioning with cyclosporine a reduces early renal dysfunction by inhibiting mitochondrial permeability transition.

Background: Ischemia-reperfusion (IR) injury leads to mitochondrial permeability transition pore opening, which contributes to cell death. The aim of this study is to determine whether ischemic or pharmacological postconditioning with cyclosporine A (CsA) might protect the kidney from lethal reperfusion injury.

Methods: Male mice underwent a unilateral (right) nephrectomy followed by 30 minutes of contralateral (left) clamping of the renal artery.

Early mortality in dialysis and adequacy of predialysis renal care: the picture is more complex than we thought.

Two new studies examine clinical events during early dialysis. Foley et al. underline a probable ascertainment bias affecting the mortality rate during the first 6 weeks and find that age is the major risk factor for very early mortality, which can be amplified by short time of predialysis nephrology care.

To live with normal GFR: when higher is not better.

Eriksen et al. unmask an independent link between a high glomerular filtration rate (GFR) and subclinical cardiovascular damage in a large cohort of nondiabetic middle-aged people in Tromsø, Norway. Although others have previously reported an association between estimated GFR and cardiovascular risk factors, the present work is remarkable in that it relies on measured GFR, thus overcoming potential bias of the limited accuracy of common GFR estimates in individuals with high GFR values.

[Kidney aging: a predictable and partly avoidable fragility].

The 9th World Kidney Day, on 13 March 2014, was devoted to the topic of renal aging. The proportion of older people in the general population is increasing steadily worldwide, with the most rapid growth in developing countries. This demographic upheaval is a consequence of socioeconomic development and increasing life expectancy.

Evaluation of renal function in patients with cirrhosis: where are we now?

In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive.

[Physical activity and chronic kidney disease: an update in 2013?].

The practice of physical activity is now a subject of special attention in public health. Indeed, the expected benefits in terms of cardiovascular morbidity and mortality suggest that all physicians should promote it. However, there are few data on the impact of physical activity on the health of patients with chronic kidney disease before the dialysis stage.

Creatinine- versus cystatine C-based equations in assessing the renal function of candidates for liver transplantation with cirrhosis.

Unlabelled: Renal dysfunction is frequent in liver cirrhosis and is a strong prognostic predictor of orthotopic liver transplantation (OLT) outcome. Therefore, an accurate evaluation of the glomerular filtration rate (GFR) is crucial in pre-OLT patients. However, in these patients plasma creatinine (Pcr) is inaccurate and the place of serum cystatine C (CystC) is still debated.

Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study.

Background: Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evaluated the effect of planned and coordinated patient management within a dedicated renal care network comparatively to standard renal care delivered in nephrology departments of teaching hospitals.

[Comparison of methods estimating a quantitative parameter: evaluation of the agreement].

Many quantitative clinical, biological and radiological parameters are useful in medicine for guiding diagnosis and therapy. The nephrologists use such parameters on a daily basis, particularly to assess renal function. In order to use the measurement methods of these parameters in clinical practice, it is mandatory to establish the agreement of the values provided, comparatively to the value obtained by using the reference measurement method of this parameter.

[Natural course of chronic kidney disease].

The natural history of chronic kidney disease describes a progressive decrease in renal function assessed by glomerular filtration rate. After the initial phase, this decrease is related to the occurence of physiological adaptation mechanisms independent of the primary renal disease. It is accompanied by the gradual appearance of clinical and metabolic abnormalities that can be largely prevented by early management including careful monitoring and appropriate treatments.

[Evaluation of renal oxygen content by BOLD MRI].

Blood Oxygen Level-Dependent (BOLD) MRI signal is a new method of renal functional imaging which allows renal cortical and medullary oxygen contents measurement in a noninvasive way and without injection of potentially nephrotoxic contrast product. Several clinical and experimental studies showed its potential interest in measuring renal oxygen content and its variation during different renal injuries, allowing new progress in the comprehension of the pathophysiology of several nephropathies.

[Contribution of X-ray computed tomography in the evaluation of kidney performance].

X-ray computer assisted tomography scanner is an imaging method based on the use of X-ray attenuation in tissue. This attenuation is proportional to the density of the tissue (without or after contrast media injection) in each pixel image of the image. Spiral scanner, the electron beam computed tomography (EBCT) scanner and multidetector computed tomography scanner allow renal anatomical measurements, such as cortical and medullary volume, but also the measurement of renal functional parameters, such as regional renal perfusion, renal blood flow and glomerular filtration rate.

Renal perfusion: noninvasive measurement with multidetector CT versus fluorescent microspheres in a pig model.

Purpose: To validate the measurement of renal perfusion with multidetector computed tomography (CT) with a low-rate injection of contrast medium (ie, 3 mL/sec) through a catheter placed peripherally with gamma variate extended modeling in a pig model, compared with a reference method of fluorescent microspheres.

Materials And Methods: This study was approved by the Institutional Animal Care and Use Committee. Renal perfusion was measured in 10 anesthetized pigs simultaneously with multidetector CT and with fluorescent microspheres, which are the reference standard for measuring regional renal perfusion.

Performance of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in diabetic patients.

Objective: The best method to estimate glomerular filtration rate (GFR) in diabetic patients is still largely debated. We compared the performance of creatinine-based formulas in a European diabetic population.

Research Design And Methods: We compared the performance of Cockcroft and Gault, simplified Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equations in 246 diabetic patients by calculating the mean bias and the interquartile range (IQR) of the bias, 10% (P10) and 30% (P30) accuracies, and Bland-Altman plots.

Which creatinine and cystatin C equations can be reliably used in children?

Background And Objectives: Estimation of GFR in children is challenging; reference methods are cumbersome, and formulas have limitations. The aims of this study were to evaluate (1) the new creatinine-based formula recently proposed by Schwartz using a kinetic colorimetric compensated Jaffe technique; (2) some cystatin C-derived formulas (Hoek, Le Bricon, Larsson, Rule, Filler, and Zappitelli) using a nephelemetric technique; and (3) combined formulas using both cystatin and creatinine (Zappitelli and Bouvet).

Design, Setting, Participants, & Measurements: These formulas were evaluated in a cross-sectional cohort of 252 children with moderate CKD or normal GFR, in comparison with the reference standard (inulin clearance, iGFR).

Evolution of renal oxygen content measured by BOLD MRI downstream a chronic renal artery stenosis.

Background: A decrease in renal oxygen content can be measured non-invasively by the increase of the R2* value derived from blood oxygen level-dependent magnetic resonance imaging (BOLD MRI). The aim of this study was to test if renal hypoxia occurs in kidneys downstream a chronic and unilateral renal artery stenosis.

Methods: Chronic renal ischaemia was induced in rats using a calibrated clip inserted on the right renal artery.

Hemodynamic responses to acute and gradual renal artery stenosis in pigs.

Background: Reduction of renal blood flow (RBF) due to a renal artery stenosis (RAS) can lead to renal ischemia and atrophy. However in pigs, there are no data describing the relationship between the degree of RAS, the reduction of RBF, and the increase of systemic plasma renin activity (PRA). Therefore, we conducted a study in order to measure the effect of acute and gradual RAS on RBF, mean arterial pressure (MAP), and systemic PRA in pigs.

What is the best alternative to inulin clearance to estimate GFR in patients with decompensated alcoholic cirrhosis?

Background: Accurate evaluation of the glomerular filtration rate (GFR) in patients awaiting liver transplantation is important because they have a greater risk of impaired renal function. A major percentage of these patients have alcoholic cirrhosis, and the accuracy of bedside used GFR estimates have not been specifically evaluated in this group. The aim of this study was to evaluate the validity of the simplified Modification of Diet in Renal Diseases (MDRD) and Cockcroft and Gault (CG) formulas in patients with decompensated alcoholic cirrhosis in comparison to inulin clearance as the reference method.

Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II-IV chronic kidney disease.

Bone fragility is a complication of chronic kidney disease (CKD). The aim of this study was to assess whether volumetric bone mineral density (vBMD) and microarchitecture could be impaired early in the course of CKD. Bone microarchitecture was examined with a noninvasive 3D imaging technique [high-resolution peripheral quantitative computed tomography (HR-pQCT)] at the tibia and radius in 70 stage II-IV CKD patients older than 50 years of age; controls belonged to two cohorts of healthy subjects comparable for age and gender (OFELY cohort in women and STRAMBO cohort in men).

Impact of automated peritoneal dialysis on initial graft function after renal transplantation.

In this retrospective study, we evaluated the impact of automated peritoneal dialysis (APD) on initial graft function after cadaveric renal transplantation. Each patient on APD was matched for donor age, donor serum creatinine, and cold ischemia time with one control patient on HD. The study sample consisted of 67 cases and 67 controls.