Monitoring of renal function in patients with spinal cord injury

MacDiarmid, Scott; McIntyre, W; Anthony, A.; Bailey, Ross R.; Turner, John G.; Arnold, E. P.

doi:10.1046/j.1464-410x.2000.00680.x

Cited by 59 publications

(47 citation statements)

References 11 publications

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“…In patients with SCI serum creatinine is often signi®cantly decreased as a result of the di use muscle atrophy which commonly accompanies muscle denervation. 24 In patients with SCI normal serum creatinine values could conceal a clinically signi®cant reduction in GFR. Therefore it would be of value to have a simple, safe test to measure renal function.…”

Section: Discussionmentioning

confidence: 99%

Serum cystatin C as a marker of the renal function in patients with spinal cord injury

et al. 2002

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Objective: To investigate the relationship between serum cystatin C, serum creatinine, and 51 Cr-EDTA-clearance in patients with spinal cord injury. Setting: The Spinal Cord Unit, Viborg-Kjellerup County Hospital. Methods: Twenty-four men and seven women aged 20.3 to 68.0 years with motor complete spinal cord injury (ASIA A or B) were included. Serum cystatin C was measured by an automated particle-enhanced nephelometric immunoassay (Dade Behring), serum creatinine by an enzymatic method (Vitros 950), and 51 Cr-EDTA-clearance by a multiple plasma sample method. Results: A linear relationship was found between 51 Cr-EDTA-clearance and the reciprocal values of cystatin C and creatinine. The correlation coe cient between 51 Cr-EDTA-clearance and 1/cystatin C was 0.72 compared to the correlation coe cient between 51 Cr-EDTAclearance and 1/creatinine being 0.26. Comparison of the area under the curves in the nonparametric receiver operating characteristics (ROC) plots for serum cystatin C (area under the curve (AUC)=0.912; SE=0.065), and serum creatinine (AUC=0.507; SE=0.115) revealed signi®cant di erences (P-values=0.0005). Conclusion: In patients with spinal cord injury serum cystatin C is a better marker of the renal function compared to serum creatinine.

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Section: Discussionmentioning

confidence: 99%

Serum cystatin C as a marker of the renal function in patients with spinal cord injury

et al. 2002

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“…Despite numerous attempts to evaluate the follow-up program, the best method to monitor the renal function in this patient group has not yet been established. 1 A widely used method is the repeated measurement of plasma creatinine (p-creatinine), 2 and equations like the Cockcroft and Gault or MDRD (modification of diet in renal disease) equations have been derived to estimate glomerular filtration rate (GFR) from p-creatinine, age, weight and gender. 3,4 P-creatinine is primarily derived from the metabolism of creatine and phosphocreatine in muscles.…”

Section: Introductionmentioning

confidence: 99%

“…5 Patients with SCI often have a reduced muscle mass because of diffuse muscle atrophy and for this reason the level of p-creatinine is often decreased in such patients. 2 The hypothesis that p-creatinine overestimates the renal function in this patient group has been demonstrated in several studies since the 1980s, [6][7][8][9] but despite this p-creatinine is still a commonly accepted method to monitor renal function in SCI patients. Recognizing this, we wanted to investigate if there was a trend in the level of p-creatinine over a 50-year follow-up period and how well p-creatinine correlated with renal deterioration.…”

Section: Introductionmentioning

confidence: 99%

50 years follow-up on plasma creatinine levels after spinal cord injury

2014

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Study design: Retrospective chart review. Objectives: To investigate the role of plasma creatinine (p-creatinine) in monitoring renal deterioration in patients up to 50 years after spinal cord injury (SCI). Setting: The Clinic for Spinal Cord Injuries, Rigshospitalet, Denmark. Methods: A total of 119 patients with a traumatic SCI during the years were included in the study. P-creatinine measurements, results from renography and glomerular filtration rate (GFR) measured with 51 Cr-EDTA clearance were obtained from medical records and analyzed using a linear mixed model and linear regression analyses. Results: When compared with median p-creatinine level in the first 5-year period after injury, the level of p-creatinine was stable throughout the first 30 years and decreased significantly after the 30th until 45th year post injury. Only patients with a functional distribution outside the 30-70% limits on renography or a relative GFR p51% of that expected had a significantly elevated level of p-creatinine. Significance was not found for patients with a distribution outside the 40-60% limits on renography or relative GFR p75%. By comparing Cr-EDTA clearance and p-creatinine in terms of exceeding the upper reference level, p-creatinine revealed 17% sensitivity, 100% specificity, 100% positive predictive value and 73% negative predictive value as a diagnostic test for renal deterioration defined as GFR p75%. Conclusion: P-creatinine decreases over time in patients with SCI with a level below the upper reference limit and is a poor detector of early renal deterioration in patients with SCI.

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“…1 Likewise, other studies have found that patients with SCI have significantly low SCr, therefore, CL CG is overestimated. [2][3][4] Such findings may be because of reduced creatinine production caused by diffuse muscle atrophy and persistent immobility. Overestimation of GFR results in dosing renally cleared medications higher than recommended, and this could lead to supratherapeutic vancomycin and AG serum levels leading to adverse drug effects and/or toxicity.…”

Section: Introductionmentioning

confidence: 99%

“…10 However, data on the application of MDRD in pharmacokinetic dosing of vancomycin and AG are inconsistent, while there is no data to date on CKD-EPI. [11][12][13][14] The objectives of this study are: (1) to evaluate different methods of estimating GFR compared with patient-specific vancomycin and AG drug clearance (CL DRUG ) in SCI patients, (2) to assess whether there is a difference in the estimation of renal function between anatomical degrees of SCI when compared with CL DRUG and (3) to develop a new equation to more accurately estimate GFR in SCI patients in order to optimize dosing for vancomycin and AG.…”

Section: Introductionmentioning

confidence: 99%