Search

Background The Chronic Kidney Disease in Children (CKiD) study reported new formulae to estimate glomerular filtration rate (eGFR). The study reported here aimed to assess the accuracy of these formulae in estimating levels and changes in GFR in pediatric renal transplant recipients and generate a new formula in our cohort. Methods Two hundred and fifty-two studies of plasma disappearance of [sup.125]I-iothalamate ([C.sub.IO]) were used to measure GFR in 1 renal transplant recipients. The CKiD bedside formula (CKiD-BS) was compared with [C.sub.IO]. A mixed logistic regression model was fit to evaluate the performance of estimating change in posttransplant [C.sub.IO] using CKiD-BS. We used mixed-effects linear regression to fit a multiplicative model of [C.sub.IO]. The CKiD cystatin-C-based formula (CKiD-Cys) was also used for comparison in 32 additional transplant recipients. Comparisons were made using Bland-Altman plots. Results CKiD-BS underestimates [C.sub.IO] by 20% for GFR > 25 ml/min per 1.73 [m.sup.2]. Percentage change in CKiD-BS performed reasonably well in estimating 15% change of [C.sub.IO] beginning 6 months posttransplant [area under the curve (AUC) = 0.791)] The multiplicative constant in the CKiD-BS was recalibrated [R-Bedside=0.461 xht(cm)/[S.sub.Cr]).]A GFR model [GFR-M)=10.73x[(ht(cm)]0.51/([S.sub.Cr])0.90x(BUN)0.23] has higher specificity but similar sensitivity for [C.sub.IO] compared with R-Bedside. CKiD-Cys overestimates [C.sub.IO] by 10 ml/min per 1.73 [m.sup.2] across a broad range of GFR. Conclusions In our cohort, the CKiD-BS underestimates [C.sub.IO]; however, changes in CKiD-BS can be used to estimate changes in [C.sub.IO]. CKiD-Cys overestimates [C.sub.IO] and is not accurate in estimating [C.sub.IO]. Keywords Pediatric kidney transplantation * Glomerular filtration rate * [sup.125]I-iothalamate clearance, Introduction Renal function is best evaluated by glomerular filtration rate (GFR) [1, 2]. The use of formulae to estimate GFR (eGFR) in renal transplant recipients has been shown to be [...]

The present study examined whether a prenatal low-protein diet programs a decrease in glomerular filtration rate (GFR) and an increase in systolic blood pressure (BP). In addition, we examined whether altering the postnatal nutritional environment of nursing neonatal rats affected GFR and BP when rats were studied as adults. Pregnant rats were fed a normal (20%) protein diet or a low-protein diet (6%) during the last half of pregnancy until birth, when rats were fed a 20% protein diet. Mature adult rats from the prenatal low-protein group had systolic hypertension and a GFR of 0.38 ± 0.03 versus 0.57 ± 0.05 ml·min-1·100 g body wt-1 in the 20% group (P < 0.01). In cross-fostering experiments, mothers continued on the same prenatal diet until weaning. Prenatal 6% protein rats cross-fostered to a 20% mother on day 1 of life had a GFR of 0.53 ± 0.05 ml·min-1·100 g body wt-1, which was not different than the 20% group cross-fostered to a different 20% mother (0.45 ± 0.04 ml·min-1·100 g body wt-1). BP in the 6% to 20% group was comparable with the 20% to 20% group. Offspring of rats fed either 20% or 6% protein diets during pregnancy and cross-fostered to a 6% mother had elevated BP but a comparable GFR normalized to body weight as the 20% to 20% control group. Thus, a prenatal low-protein diet causes hypertension and a reduction in GFR in mature adult offspring, which can be modified by postnatal rearing. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of tumour staging and nodal metastases in predicting 5- year's survival after radical cystectomy and bilateral pelvic lymphadenectomy for primary bladder cancer., Methods: During the period 1995 to 2005, 58 patients underwent radical cystectomy and bilateral pelvic lymphadenectomy and urinary diversion at a University hospital. Patients were identified using medical indexing coding system (ICD 9CM) using standard key words. The patient records were analyzed and follow up data updated. Disease specific survival, death or recurrence was taken as end point., Results: Out of 58 patients, 50 (86%) were males and 8 (14%) females with a mean age of 61 +/- 13.1 years (range from 27 to 87 years). Of 58 patients, 11 (23%) were excluded from the study because of in adequate follow up. The mean follow up was 5.7 years (range, 7 months to 11 years). The overall 5 years survival was 55% with disease specific survival being 66%. Patients with pathological stage TO at cystectomy have 87% 5 years disease specific survival compared to 60%, in patients with pT4 (p = 0.705). The 5-year survival for node positive patients was 16%, compared to 60% for node negative patients (p < 0.01)., Conclusions: Radical cystectomy and bilateral pelvic lymphadenectomy is the standard treatment for muscle invasive and high grade T1 cancers, and as salvage for recurrent cancers. Lymphadenectomy has a potential therapeutic benefit. The pathological stage at cystectomy and nodal status are predictors of 5 years survival.