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Establishing the presence or absence of chronic kidney disease:Uses and limitations of formulas estimating the glomerular filtration rate

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World Journal of Methodology 2017年第3期7卷 73-92页

作者： Ahmed Alaini Deepak Malhotra helbert rondon-berrios Christos P Argyropoulos Zeid J Khitan Dominic SC Raj Mark Rohrscheib Joseph I Shapiro Antonios H Tzamaloukas Division of Nephrology Department of MedicineUniversity of New Mexico School of Medicine Division of Nephrology Department of MedicineUniversity of Toledo School of Medicine Renal and Electrolyte Division Department of MedicineUniversity of Pittsburgh School of Medicine Division of Nephrology Department of MedicineJoan C. Edwards School of Medicine Division of Nephrology Department of MedicineGeorge Washington University Marshall University Joan C. Edwards School of Medicine Nephrology Section Medicine ServiceRaymond G. Murphy VA Medical Center Department of Medicine University of New Mexico School of Medicine

The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and *** scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.

关键词： Chronic kidney disease Serum creatinine Creatinine clearance Creatinine excretion Estimated glomerular filtration rate Cystatin C Renal imaging Hyperfiltration Biomarkers of chronic kidney disease

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Hypertonicity:Clinical entities,manifestations and treatment

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World Journal of Nephrology 2017年第1期6卷 1-13页

作者： helbert rondon-berrios Christos Argyropoulos Todd S Ing Dominic S Raj Deepak Malhotra Emmanuel I Agaba Mark Rohrscheib Zeid J Khitan Glen H Murata Joseph I Shapiro Antonios H Tzamaloukas Renal-Electrolyte Division Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Medicine Strich School of MedicineLoyola University ChicagoMaywoodIL 60153United States Division of Nephrology Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephrology Department of MedicineSchool of MedicineUniversity of ToledoToledoOH 43614-5809United States Division of Nephrology Department of MedicineJos University Teaching HospitalJosPlateau State 930001Nigeria Division of Nephrology Department of MedicineSchool of MedicineMarshall University Joan C.EdwardsHuntingtonWV 25701United States Informatics Section Medicine ServiceRaymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States Department of Medicine University of New Mexico School of MedicineAlbuquerqueNM 78108United States Marshall University Joan C.Edwards School of Medicine HuntingtonWV 25701United States Section of Nephrology Medicine Service(111C)Raymond G.Murphy Veterans Affairs Medical CenterAlbuquerqueNM 78108United States

Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypo-volemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium defcit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the frst component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fuid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtainedby the corrected sodium concentration, which representsa calculated value of the serum sodium concentrationthat would result from reduction of the serum glucoseconcentration to a normal level.

关键词： Hypertonicity Hypernatremia Osmotic diuresis Hyperglycemia Water diuresis

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Fluid balance concepts in medicine:Principles and practice

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World Journal of Nephrology 2018年第1期7卷 1-28页

作者： Maria-Eleni Roumelioti Robert H Glew Zeid J Khitan helbert rondon-berrios Christos P Argyropoulos Deepak Malhotra Dominic S Raj Emmanuel I Agaba Mark Rohrscheib Glen H Murata Joseph I Shapiro Antonios H Tzamaloukas Division of Nephrology Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87131United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87131United States Division of Nephrology Department of MedicineJoan Edwards School of MedicineMarshall UniversityHuntingtonWV 25701United States Division of Renal and Electrolyte Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA 15260United States Division of Nephrology Department of MedicineUniversity of Toledo School of MedicineToledoOH 43614-5809United States Division of Renal Disease and Hypertension Department of MedicineGeorge Washington UniversityWashingtonDC 20037United States Division of Nephology Department of MedicineJos University Medical CenterJosPlateau State 930001Nigeria Research Service Raymond G Murphy VA Medical Center and University of New Mexico School of MedicineAlbuquerqueNM 87108United States 不详

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water(TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment(mainly sodium salts) and in the intracellular compartment(mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume(EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illne

关键词： Body fluids Body water Extracellular volume Hypertonicity Hypotonicity Congestive heart failure Hepatic cirrhosis Sepsis Nephrotic syndrome

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