Abstract. Christensson AG, Grubb AO, Nilsson J-Å , Norrgren K, Sterner G, Sundkvist G (Malmö University Hospital, Malmö; and Lund University Hospital, Lund, Sweden). Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy. J Intern Med 2004; 256: 510-518.Objective. To determine whether serum cystatin C is more accurate than serum creatinine in the detection of diabetic nephropathy, also after adjustment for age. Methods. Forty-one patients with type 1 and 82 patients with type 2 diabetes were evaluated with serum creatinine, serum cystatin C, and 51 Cr-EDTA clearance (reference method). Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Statistical estimations were performed both without and with age adjustment created by z-scores for 51 Cr-EDTA clearance, creatinine, and cystatin C. The cut-off levels for glomerular filtration rate (GFR) ( 51 Cr-EDTA clearance) were 60 and 80 mL min )1 1.73 m )2 , respectively, in absolute values and 80, 90 and 95% CIs, respectively, in age-adjusted values (z-scores).Results. Estimations without age adjustment showed significantly (P ¼ 0.0132) closer correlation for cystatin C (r ¼ 0.817) versus 51 Cr-EDTA clearance as compared with creatinine (r ¼ 0.678). However, when using age-adjusted values, the correlation for cystatin C and creatinine, respectively, versus 51Cr-EDTA clearance did not differ. When comparing the diagnostic utilities for serum cystatin C versus serum creatinine in manifest renal impairment (GFR < 60 mL min )1 1.73 m )2 or z-scores <)1.28 SD), there were no significant differences between the two markers whether age adjusted or not. However, for diagnosing mild nephropathy (GFR < 80 mL min )1 1.73 m )2 or z-score )0.84 SD), serum cystatin C is significantly more useful. Conclusions. Serum cystatin C performed better compared with serum creatinine even when measured enzymatically, to detect mild diabetic nephropathy. However, serum creatinine was as efficient as serum cystatin C to detect advanced diabetic nephropathy.

A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy. Link to publication Citation for published version (APA): Forsén, A., Kangro, M., Sterner, G., Norrgren, K., Thorsson, O., Wollmer, P., & Sundkvist, G. (2004). A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy. Diabetic Medicine, 21(8), 852-858. DOI: 10.1111/j.1464-5491.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractAims Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.Methods Autonomic nerve function was assessed by heart-rate responses to deep breathing (E / I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria > 20 µ g/ min or > 0.03 g /24 h) and glomerular filtration rate ( 51 Cr-EDTA plasma clearance). The acceleration index had deteriorated after 7 years ( P = 0.0155), whereas the E/I ratio ( P = 0.0070) and the diastolic postural blood pressure reaction ( P = 0.0054) had deteriorated 14 years after the baseline examination (age-corrected values). All those with albuminuria at the third examination showed signs of autonomic neuropathy at baseline (10 of 10) compared with only nine of 22 without ( P = 0.0016). Multiple regression analysis showed that the association between autonomic dysfunction and future albuminuria was due to the E / I ratio. In addition, individuals with an abnormal postural diastolic blood pressure fall ( n = 7) at baseline showed a greater fall in glomerular filtration rate more than others 7-14 years later [29 (16.5) ml/min/1.72 m 2 vs. 11 (9) ml/min/1.72 m 2 ; P = 0.0074].Conclusion Autonomic nerve function had deteriorated after 14 years. Autonomic neuropathy and abnormal postural diastolic blood pressure falls at baseline were associated with future renal complications.Diabet. Med. 21, 852-858 (2004)

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The accuracy in determination of organ activity of (99m)Tc was investigated, with activity estimated from gamma camera images of phantoms, using the conjugate view method. The accuracy depends on several parameters such as the choice of background correction method, the accuracy in determination of the effective attenuation coefficient and the thickness of the body and organs and on the determination of the gamma camera sensitivity. The background correction method has a major influence on the quantification of the activity. Methods which take the volume of the source organ into consideration are recommended. The discrepancy in the determined organ activity varied between an underestimation of 26% and an overestimation of 16% in the MIRD phantom, depending on which organ was studied and on the correction method used. To correct for absorption and scattering, an effective attenuation coefficient was used. A theoretical analysis showed that a change in the effective attenuation coefficient of 0.01 cm(-1) resulted in a 15% change in the calculated activity. Also the thickness of the body and the organ of interest influences the calculated activity. A 2 cm deviation in the body thickness causes a deviation of approximately 10% in the calculated activity. The quantification is improved if the attenuation coefficient is determined by transmission measurements.

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