The Top 10 Things Nephrologists Wish Every Primary Care Physician Knew

Paige, Neil M.; Nagami, Glenn T.

doi:10.4065/84.2.180

Cited by 31 publications

(18 citation statements)

References 33 publications

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“…CKD patients have an increased risk of morbidity and mortality compared with the general population. Hence, the identification of possible risk factors associated with the development of renal disease has become an important focus area for researchers [11,12]. Because the incidence of CKD has been increasing worldwide over the last decades, the frequency of renal stone disease has also increased [1].…”

Section: Discussionmentioning

confidence: 99%

Renal function in patients with urinary stones of varying compositions

Chou

Hsu

et al. 2011

The Kaohsiung J of Med Scie

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Kidney stones are a potential risk factor for chronic kidney disease. The impact of different urinary stone components on renal function is unknown. In this study, we retrospectively reviewed 1,918 medical records of patients with urolithiasis. The renal function was evaluated as estimated glomerular filtration rate. All the stones were analyzed by Fourier transform infrared spectroscopy. The patients were divided into five groups according to the stone components. Statistical analysis was performed with analysis of variance. All the patients with stones had Stage 2-3 chronic kidney disease. The patients with uric acid and struvite stones had significantly lower estimated glomerular filtration rate compared with those having other stone components (p<0.01). Furthermore, the patients with calcium-containing stones (calcium oxalate and calcium phosphate) had significantly better renal function than those with non-calcium-containing stones (struvite and uric acid, p<0.01). Patients with urolithiasis had decreased renal function, and the impact of renal function varied depending on the stone components. We conclude that stone analysis is important in predicting the change in renal function in patients with urolithiasis. Moreover, the patients with non-calcium-containing stones, such as struvite and uric acid stones, should be carefully evaluated and treated to preserve their renal function.

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Section: Discussionmentioning

confidence: 99%

Renal function in patients with urinary stones of varying compositions

Chou

Hsu

et al. 2011

The Kaohsiung J of Med Scie

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“…At last follow-up however, five patients persisted with grade 1 renal toxicity and the remainder had no CTCAE-defined toxicities. Regarding post-nadir trends, by last follow-up, creatinine was stable (within 20% of baseline [22–24]) in 17 patients, increased in 15 patients, and decreased in six patients.…”

Section: Resultsmentioning

confidence: 99%

Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial

et al. 2017

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BackgroundThis is the first known study examining renal function following stereotactic body radiotherapy (SBRT) for pancreatic head adenocarcinoma.MethodsThirty-eight borderline-resectable/unresectable patients, part of an ongoing prospective trial, underwent 3 cycles of gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5/6/7/8 Gy) and concurrent nelfinavir. Thereafter, in resectable cases, surgery was performed within 4–8 weeks. The last available pre-SBRT creatinine was recorded, along with the highest post-SBRT value. Glomerular filtration rate (GFR) was calculated by the commonly-utilized Modification of Diet in Renal Disease formula. GFR decline was defined as the post-SBRT nadir GFR minus the pre-SBRT GFR. Correlations with the V5–V30, and mean/maximum kidney doses was performed. Statistics included Pearson correlation, Mann-Whitney, and Fisher’s exact tests.ResultsThe median total kidney volume was 355 cm3. Median dosimetric values were as follows: V5 (209 cm3), V10 (103 cm3), V15 (9 cm3), V20 (0 cm3), V25 (0 cm3); and mean (6.7 Gy) & maximum kidney dose (18.3 Gy). Median GFR change was −23 (range, −105 to 25) mL/min/1.73 cm2. Of all dosimetric parameters, only V5 was significantly associated with changes in GFR (Pearson r = −0.40, p = 0.012). In patients with V5 < 210 cm3, median GFR change was −11.8 mL/min/1.73 cm2, as compared with −37.1 mL/min/1.73 cm2 change in those with V5 ≥ 210 cm3 (p = 0.02). A GFR change < −23 mL/min/1.73 cm2 was observed in 6/20 (30%) patients with V5 < 210 cm3, versus 15/18 (83%) of those with V5 ≥ 210 cm3. Patients with V5 ≥ 210 cm3 were over ten times as likely to have GFR change < −23 mL/min/1.73 cm2 (p = 0.003). Using linear regression, GFR change ≈ −0.1748 × V5(cm3) + 8.63.ConclusionsIn the first known analysis of renal function after pancreatic SBRT, evaluating patients on a prospective study, V5 ≥ 210 cm3 was associated with a post-SBRT GFR decline of >23 mL/min/1.73 cm2. If V5 is kept <210 cm3, median GFR decline was only 11.8 mL/min/1.73 cm2. Further validation is needed to ascertain definite dose-volume parameters and examine late renal decline.

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“…These methods are either too insensitive, such as conventional serum tests (eg, serum creatinine), or too invasive, such as kidney biopsy with potential complications (eg, bleeding) . Patients who have serum creatinine levels within the “normal” range may nonetheless have a substantial reduction in kidney function, which can be seen in stage III of CKD . In addition, there are patients who would not meet the criteria for immunotherapy if interstitial fibrosis and scarring are present.…”

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confidence: 99%

“…9 Patients who have serum creatinine levels within the "normal" range may nonetheless have a substantial reduction in kidney function, which can be seen in stage III of CKD. 1,10 In addition, there are patients who would not meet the criteria for immunotherapy if interstitial fibrosis and scarring are present. Currently, biopsy is the reference standard to determine this condition; however, if it could be accurately detected and monitored by an ultrasound technique, it would prevent the need for an invasive procedure.…”

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confidence: 99%

Multiparametric Quantitative Ultrasound Imaging in Assessment of Chronic Kidney Disease

Gao

Perlman

Kalache

et al. 2017

J of Ultrasound Medicine

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Purpose To evaluate the value of multiparametric quantitative ultrasound imaging (QUI) in assessing chronic kidney disease (CKD) using kidney biopsy pathology as the reference standard. Methods We prospectively measured multiparametric QUI markers with grayscale, spectral Doppler, and acoustic radiation force impulse imaging in 25 patients with CKD prior to their kidney biopsies and in 10 healthy volunteers. Based on all pathology (glomerulosclerosis, IF/TA, arteriosclerosis, and edema) scores, the 25 CKD patients were classified into mild (no grade 3 and < 2 of grade 2) and moderate to severe (at least 2 of grade 2 or 1 of grade 3) CKD groups. Multiparametric QUI in the study included kidney length, cortical thickness, pixel-intensity, parenchymal shear wave velocity (SWV), intrarenal artery peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI). We tested the difference in QUI parameters among mild CKD, moderate to severe CKD, and healthy controls using ANOVA, analyzed correlations of QUI parameters to kidney pathology scores and to eGFR using the Pearson correlation coefficient, and examined the diagnostic performance of QUI parameters in determining moderate CKD and eGFR <60 using ROC curve analysis. Results There were significant differences in cortical thickness, pixel-intensity, PSV, and EDV among the 3 groups (all p< 0.01). Among QUI parameters, the top AUROCs of PSV and EDV for determining pathologic moderate to severe CKD were 0.88 and 0.97, and for eGFR <60 were 0.76 and 0.86, respectively. Moderate to good correlations were found for PSV, EDV, and pixel-intensity to pathology score and eGFR. Conclusion PSV, EDV, and pixel-intensity are valuable in determining moderate to severe CKD. The value of SWV in assessing CKD needs further investigation.

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The Top 10 Things Nephrologists Wish Every Primary Care Physician Knew

Cited by 31 publications

References 33 publications

Renal function in patients with urinary stones of varying compositions

Renal function in patients with urinary stones of varying compositions

Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial

Multiparametric Quantitative Ultrasound Imaging in Assessment of Chronic Kidney Disease

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