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Abstract: Purpose: High variability has been observed in the estimation of the glomerular filtration rate (GFR) in older patients, according to the formula used and no single formula has been recommended to date. The aim of this study was to quantify the precision and accuracy of the GFR estimated by means of three formulas and the measurement of cystatin C. Methods: This prospective study was conducted in an acute care geriatric unit. Participants were patients, aged 70 years and over, having a possible 24-hour urine collection. The GFR was estimated using the Cockroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Creatinine Clearance (Cl-Cr) formulas. The serum level of cystatin C was also measured. Results: Eighty-one patients were included in the study. CG formula underestimated the GFR by a mean difference of 8.65ml/min, compared with MDRD formula. Cl-Cr underestimated the GFR by a mean difference of 7.56ml/min, compared with CG formula, and by a mean difference of 16.79ml/min, compared with the MDRD formula. The degree of discrepancy between CG and Cl-Cr estimates, and between Cl-Cr and MDRD estimates decreased as the estimated GFR approached normal values. MDRD best matched the measurement of cystatin C, followed by CG and Cl-Cr (Kappa coefficient=0.43, 0.22 and 0.16, respectively). Conclusion: Our study confirms the high variability of GFR in older patients and particularly in those with abnormal renal function, depending on the formula used. Serum cystatine C level and MDRD formula appear to be the most concordant estimates of GFR in this population. [Copyright &y& Elsevier]

La nécrose hémorragique des surrénales est une urgence diagnostique et thérapeutique. Elle doit faire rechercher un syndrome des anti-phospholipides, ce d'autant qu'il s'agit d'une manifestation inaugurale dans un tiers des cas. Le traitement de référence du syndrome des anti-phospholipides reste les anti-vitamines K mais le développement des anticoagulants oraux notamment dans la maladie thromboembolique veineuse, a fait discuter leur place dans cette pathologie. Fort de l'expérience des dernières années, les nouvelles recommandations françaises déconseillent l'utilisation des anticoagulants oraux directs dans le syndrome des anti-phospholipides. Nous rapportons un cas de nécrose hémorragique bilatérale des surrénales chez un patient de 47 ans traité depuis deux mois par apixaban pour maladie thromboembolique veineuse, révélant secondairement un syndrome des antiphospholipides primitif triple positif. Il s'agit, à notre connaissance, du premier cas rapporté de nécrose bilatérale des surrénales sous apixaban en contexte de syndrome des anti-phospholipides. L'échec des anticoagulants oraux pour la prévention des récidives thrombotiques chez ce patient illustre le bien fondé des nouvelles recommandations. Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. To our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations. [ABSTRACT FROM AUTHOR]