Optimizing a kidney stress test to evaluate renal functional reserve

Sharma, Aashish; Zaragoza, José J.; Villa, Gianluca; Ribeiro, Leonardo C; Lu, Renhua; Sartori, Marco; Faggiana, Elena; Cal, Massimo de; Virzì, Grazia Maria; Corradi, Valentina; Brocca, Alessandra; Husain‐Syed, Faeq; Brendolan, Alessandra; Ronco, Claudio

doi:10.5414/cn108497

Cited by 56 publications

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“…This introduces the concept of a patient-centered 'precision' approach to CRRT prescription. This would imply that CRRT dose would be modified over time to match the clinical demands of the patient (i.e., changes to kidney reserve, changes to illness severity, changes to non-renal organ dysfunction, changes to fluid balance and metabolic status) [33] . This would be analogous to how mechanical ventilation is prescribed in critically ill patients with acute lung injury.…”

Section: Contextmentioning

confidence: 99%

Precision Continuous Renal Replacement Therapy and Solute Control

et al. 2016

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Continuous renal replacement therapy (CRRT) remains the dominant form of renal support among critically ill patients worldwide. Current clinical practice on CRRT prescription mostly relies on high quality studies suggesting no impact of CRRT dose on critically ill patients' outcomes. Recent clinical practice guidelines have been developed based on these studies recommending a static prescribed CRRT dose of 20-25 ml/kg/h. There is a rationale for renewed attention to CRRT prescription/practice based on the concept of dynamic solute control adapted to the changing clinical needs of critically ill patients. In response, Acute Disease Quality Initiative convened a 17th consensus meeting centered on re-evaluation of CRRT. This work group developed 4 themes focused specifically on CRRT dose prescription, delivery and solute control that were summarized in a series of consensus statements, along with the identification of critical knowledge gaps. CRRT dose prescription and delivery can be based on effluent flow rate. Delivered dose should be routinely monitored to ensure coherence with prescribed dose. CRRT dose should be dynamic, in recognition of between- and within-patient variation in targeted solute control or unintended solute clearance. Quality measures specific for monitoring delivered CRRT dose have been proposed that require further validation, prior to implementation, into the practice of guiding optimal CRRT dosage.

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Section: Contextmentioning

confidence: 99%

Precision Continuous Renal Replacement Therapy and Solute Control

et al. 2016

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“…Old technique of kidney stress test, which is forgotten for a long-time, despite its simplicity, it can adequately reflect the condition of intraglomerular hemodynamic and can easily realizable in clinical practice. 21 Many studies demonstrated response of basal GFR to different stimuli from usual chicken and beef meat intake to amino acid and some drugs infusions in healthy individuals. 8,9,[22][23][24][25][26] In our study we first used …”

Section: Discussionmentioning

confidence: 99%

Renal functional reserve and renal hemodynamics in hypertensive patients

et al. 2016

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The renal functional reserve (RFR) is the ability of the kidneys to increase renal plasma flow and glomerular filtration rate (GFR) in response to protein intake. It is a measure of functional and anatomic integrity of nephrons. It is not known what relation between RFR and kidney Doppler parameters. We aimed to study the relation between the RFR and renal hemodynamic parameters in hypertensive patients with and without nephropathy who had normal kidney function. Twenty-four hypertensive subjects with nephropathy (HTN-n, n ¼ 10) and hypertension without nephropathy (HTN, n ¼ 14) were included in the study. Control group included 11 healthy subjects. Baseline GFR (GFR1) and GFR after intake of egg protein 1 mg/kg of body weight were determined (GFR2). RFR was calculated by the following formula: (GFR2-GFR1)/GFR1 Â 100%. Doppler ultrasonography was performed. Arterial blood pressure (BP), body mass index (BMI), and estimated GFR were also recorded. HTN and HTN-n groups had impaired levels of RFR compared with controls (p < 0.05), significantly decreased value of flow velocity parameters (Vmax, Vmin), and increased RRI compared with controls. There was significant negative correlation of RFR with blood pressure levels (sBP, r ¼ À0.435, p ¼ 0.009; dBP, r ¼ À0.504, p ¼ 0.002), RRI (r ¼ À0.456, p ¼ 0.008), micro albuminuria (MAU, r ¼ À0.366, p ¼ 0.031) and positive correlation with Vmax and Vmin (r ¼ 0.556, p ¼ 0.001 and r ¼ 0.643, respectively, p < 0.001). Linear regression showed that RRI and MAU were independent predictors of decreased RFR. RFR is lower in hypertensive patients despite near-normal level of kidney function and is related to particular level of BP. RRI and MAU were independent predictors of decreased RFR. ARTICLE HISTORY

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“…Recent data from our group suggest that a protein-loading test with 1 g/kg of body weight is a sufficient stimulus to elicit the maximum GFR. The resultant sGFR is thought to adequately quantify the global renal capacity [41] . In our study, the sGFR before transplant does not result statistically different from the cumulative sGFR obtained in donors and recipients after transplant ( p = 0.73; Fig.…”

Section: Discussionmentioning

confidence: 99%

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

Spinelli¹,

Sharma²,

Villa³

et al. 2017

Nephron

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Background: In living kidney transplantation, preoperative donors' renal functional reserve (RFR) may correlate with postoperative residual renal function in both donors and recipients. The aim of this study was to evaluate the donors' RFR before transplantation and to compare basal and stress renal function before and after transplantation in both donors and recipients. Methods: Seven pairs of living kidney donors and recipients were considered for this observational study. RFR was measured with a renal stress test (RST) before and after the kidney transplantation through an oral protein loading test (1 g/kg of body weight). RFR was defined as the difference between the maximum value of creatinine clearance after protein load (stress glomerular filtration rate, sGFR) and baseline creatinine clearance (basal GFR, bGFR). Results: Before transplantation, a significant difference between sGFR and bGFR (p = 0.04) was observed in donors, with an RFR = 30.6 (11.9-41.5) mL/min/1.73 m². After kidney transplantation, sGFR was similar to bGFR for both donors and recipients (p = 0.13), with a limited RFR (7.9 [6.70-19.25] and 14.90 [-6.67 to 25.53] mL/min/1.73 m², respectively). The sum of the donor's and recipient's post-transplant sGFR was similar to the pre-transplant donor's sGFR (p = 0.73). Conclusion: RST is a safe, feasible, easy, and an inexpensive tool that is able to quantify RFR. In living kidney transplantation, it can be used in clinical practice to measure the original global filtration capacity of the donor's kidneys (sGFR) and to quantify the susceptibility of donors and recipients in developing postoperative kidney dysfunction. However, further studies with an adequate sample size and follow-up period are needed to test this hypothesis.

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Optimizing a kidney stress test to evaluate renal functional reserve

Cited by 56 publications

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Precision Continuous Renal Replacement Therapy and Solute Control

Precision Continuous Renal Replacement Therapy and Solute Control

Renal functional reserve and renal hemodynamics in hypertensive patients

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

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