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Objectives: Renal impairment (RI) is a predictor of poor outcomes in patients with cardiovascular disease, but its influence in the setting of percutaneous coronary intervention and zotarolimus-eluting stent (ZES) implantation has not been described. This study evaluated the impact of RI on clinical outcomes in patients participating in the E-Five Registry., Background: E-Five was a prospective, multicenter, global registry of 8,314 patients; 2,116 patients were followed to 2 years., Methods: Patients (excluding those who had undergone renal transplantation) were grouped according to renal function (normal function/mild RI, serum creatinine <110 μmol/L; moderate RI, 110-200 μmol/L; severe RI, >200 μmol/L) and their outcomes evaluated retrospectively. Major adverse cardiac events (MACE; i.e., death, myocardial infarction, emergency cardiac bypass surgery, or target lesion revascularization) and stent thrombosis events at 1 and 2 years were compared between groups., Results: The 1-year MACE rate in patients with mild RI was 6.8%, compared with 8.9 and 18.1% in patients with moderate and severe RI (P = 0.002 across groups). At 2 years, death occurred in 16% of those with severe RI, compared with 2.0 and 4.7% in those with mild and moderate RI (P = 0.002). There was no significant difference in the rates of target lesion revascularization or target vessel failure., Conclusions: Greater severity of RI at intervention is associated with greater mortality and MACE but unchanged revascularization rates after ZES implantation., (Copyright © 2012 Wiley Periodicals, Inc.)

High-dose (75 mg/m2) cisplatin is baseline chemotherapy in lung cancer. To prevent nephrotoxicity, patients generally receive saline infusion on the day of chemotherapy prior to and following cisplatin (total of 3.5-4.0 liters during 3-4 hours). Despite these measures nephrotoxicity has remained frequent, especially among patients also suffering from cardiovascular disease or diabetes mellitus. Since 2005 several international recommendations have been formed about prevention of cisplatin nephrotoxicity. According to these recommendations: 1) renal function should not be evaluated by serum creatinine concentration; 2) evaluation of renal function should be based on calculated creatinine clearance (e.g. by the Cockcroft-Gault equation); 3) patients to be treated by high-dose cisplatin should be euvolemic and should have saline diuresis (urine NaCl concentration ~1%) of at least 100 ml/hour prior to, during and several days following the administration of cisplatin. Keeping these recommendations ensures prolonged cisplatin treatability of lung cancer patients. Moreover, decreased renal function will not limit the full dose administration of several other cytotoxic agents. Losonczy G, Máthé C, Müller V, Szondy K, Moldvay J. Incidence, risk factors and prevention of cisplatin-induced nephrotoxicity in patients with lung cancer.

In November 2009 the first European guidelines were presented regarding preoperative risk assessment and perioperative management in non-cardiac surgery. They were designed by the European Society of Cardiology (ESC) and endorsed by the European Society of Anesthesiology.In a standardized manner, patient-specific clinical variables, their exercise capacity and surgery-specific risk factors are summarized to a recommendation concerning medication and preoperative cardiac evaluation. These guidelines are straightforward and feasible for cardiologists as well as specialists in internal medicine and general practicioners. Nevertheless, some points still lack evidence.

Objective: To report the results and implications for workflow following introduction of ESUR guidelines to screen for potential renal insufficiency (RI) in private practice with on-site creatinine measurements., Methods: A total of 1,766 consecutive outpatients scheduled for contrast-enhanced CT (CECT) completed the ESUR questionnaire enquiring about kidney disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout or use of nephrotoxic drugs. Patients with positive risk factors underwent on-site creatinine measurement and calculation of estimated glomerular filtration rate (eGFR). Attending radiologists adapted subsequent imaging depending on renal function and presence of risk factors., Results: One or more ESUR risk factors were present in 796 (45.1%) patients, including hypertension (37.7%), nephrotoxic medication (21.3%), diabetes mellitus (8.0%), proteinuria (3.9%), renal disease (4.1%), gout (3.1%) and renal surgery (2.6%). Pre-procedural creatinine measurements revealed severe RI (eGFR < 30 ml min(-1) 1.73 m(-2)) in 10 (1.3%) and moderate RI (eGFR 30-59 ml min(-1) 1.73 m(-2)) in 106 (13.8%). Imaging work-up was adapted in 132 (16.6%) as follows: reduction of contrast material dose (n = 85), CT without contrast (n = 40), changeover to MRI (n = 3) or scintigraphy (n = 4)., Conclusion: Screening for RI following ESUR guidelines requires creatinine measurements in nearly half of outpatients scheduled for CECT and reveals moderate to severe renal impairment in 6.6%.

In this article we summarize recommendations and guidelines for the prevention of NSF from the United States, Canada, and Europe. J. Magn. Reson. Imaging 2009;30:1357-1363. (c) 2009 Wiley-Liss, Inc.

Purpose: The aim of the study was to analyze the occurrence of primary and secondary glomerulopathies as well as tubulointerstitial nephropathies over time and to assess potential changes in the disease spectrum., Patients and Methods: The authors retrospectively analyzed all kidney biopsies performed in their institution between 1983 and 2006 as well as the clinical data at the time of biopsy., Results: Between January 1983 and December 2006, 359 native kidney biopsies with sufficient material for histological analysis were performed (218 men, 141 women; mean age 51.8 years). A mean of nine glomeruli per biopsy were obtained. Mean serum creatinine at the time of biopsy was 3.3 mg/dl. The most common indication for biopsy was nephrotic syndrome (31%), followed by renal insufficiency (29%) and proteinuria (14%). Primary glomerulopathies were found in 51%, secondary glomerulopathies in 28%, tubulointerstitial renal diseases in 9%, and vascular renal diseases in 12%. Among the primary glomerulopathies, IgA nephropathy was the most common diagnosis (26%), followed by mesangioproliferative glomerulonephritis (17%), membranous glomerulonephritis (16%), minimal change disease (14%), focal segmental glomerulosclerosis (FSGS; 13%), rapidly progressive glomerulonephritis (RPGN; 8%), and membranoproliferative glomerulonephritis (7%). Among the secondary glomerulopathies, the heterogeneous group of autoimmune diseases (26%) and diabetic nephropathy (25%) dominated. Comparing the period from 1983 to 1994 with 1995 to 2006, a decrease in primary FSGS from 16% to 9% as well as in RPGN from 14% to 1% was noticed, while among the secondary forms, autoimmune diseases with renal involvement increased from 14% to 31%., Conclusion: In the own patient population changes in the spectrum of primary and secondary glomerulopathies can be observed over time. Thereby, the distribution pattern of the various glomerulonephritides largely corresponds to the distribution described for other West European countries. An increase in the incidence of primary FSGS, as observed in non-European countries, could not be demonstrated.

Clinical trials with surrogate end points generally require smaller sample sizes and shorter duration than those with clinical outcomes. However, in practice, surrogate end points are likely to result in less comprehensive conclusions than 'outcome' end points as they sometimes reflect only partial aspects of complex phenomena. A number of conditions help to establish the validity of a particular variable as predictive of clinical outcome. This article discusses to what extent albuminuria fulfills these requisites in two particular clinical scenarios: prevention of renal deterioration and prevention of cardiovascular disease.